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Ms. Sabrina Wilson
1808-B Solomon Road
Charlottesville, VA 22901
(434) 382-7971

Current Inspector: Michelle W. Argenbright (540) 848-4123

Inspection Date: Nov. 17, 2015 and Nov. 19, 2015

Complaint Related: No

Areas Reviewed:
22VAC40-111 Administration
22VAC40-111 Personnel
22VAC40-111 Household Members
22VAC40-111 Physical Health of Caregivers and Household Members
22VAC40-111 Caregiver Training
22VAC40-111 Physical Environment and Equipment
22VAC40-111 Care of Children
22VAC40-111 Preventing the Spread of Disease
22VAC40-111 Medication Administration
22VAC40-111 Emergencies
22VAC40-111 Nutrition
22VAC40-111 Transportation
22VAC40-111 Nighttime Care
22VAC40-80 THE LICENSE.
22VAC40-80 THE LICENSING PROCESS.
63.2 General Provisions.
63.2 Licensure and Registration Procedures
63.2 Facilities and Programs..
63.2 Liability Insurance Disclosure
22VAC40-191 Background Checks for Child Welfare Agencies
54.1-3408 Provider must be MAT certified to administer prescription medication.

Comments:
An announced initial licensing inspection was conducted on November 17, 2015 between the hours of approximately 10:00 a.m. and 2:10 p.m. Ten children were enrolled and three children were in the care of one caregiver on this date. All children's records were reviewed and one caregiver's record was updated (background clearances, tuberculosis screening and first aid/cardiopulmonary resuscitation training). The home and outdoor play area were toured, available records/documents/policies were reviewed, safety equipment was examined (first aid kit, flashlight, radio and fire extinguisher) and posted information (emergency evacuation diagram, emergency telephone numbers, daily schedule and menu) was observed. No medications were administered on this date. Program observation was completed. Activities observed included: indoor play; handwashing and diapering procedures; lunch and naptime. Adult/child interactions, behavior guidance and daily routines/transitions were also observed. Follow-up was completed on November 19, 2015 between the hours of 9:15 a.m. and 10:00 a.m.

Thank you for your time and assistance during the licensing process. A recommendation will be made for the issuance of a Conditional family day home license. Please contact me if you have questions concerning this inspection, the licensing standards and/or if I may be of assistance to you (540) 430-9262.

This document was revised on January 28, 2016

Violations:
Standard #: 22VAC40-111-60-A
Description: This violation was revised on January 28, 2016.

Based on review of ten children's records and discussion with the provider on November 17, 2015, up-to-date records, containing all required documents/information, had not been obtained for all enrolled children.

1. Review of children's records, on this date, determined that the records of children A, B, E and F did not include the name of the child's medical insurance policy and/or the policy number.
2. Review of children's records, on this date, determined that the records of children A, B, E, F, G, I and J did not include complete emergency contact information (name, address and/or telephone number of two contacts).
3. Review of children's records, on this date, determined that the record of child B did not include a signed liability insurance disclosure form.
4. Review of children's records, on this date, determined that the record of child J did not include an emergency medical authorization statement signed by the child's parent.
5. Review of children's records, on this date, determined that the records of children A, B, C and H did not include a child record form (including the information listed in #1 and #2 above).
6. Review of children's records, on this date, determined that the record of child B did not include an "Information for Parents" form signed by the child's parent.
7. Review of children's records, on this date, determined that the records of children B, D, F, I and J did not include a signed "Policy for the administration of medications form."
8. Review of children's records, on this date, determined that the records of children B, D and E did not include a signed "Provisions of Home's Emergency Preparedness and Response Plan."
9. Review of children's records, on this date, determined that the records of children B, G and H did not contain an immunization record or documentation indicating the child was adequately immunized.
10. Review of children's records, on this date, determined that the records of children B, C, F, G and H did not contain documentation of a physical exam.
11. Review of children's records, on this date, determined that the records of children A, B, F, G and H did not contain documentation of age/identity.
12. Review of children's records, on this date, determined that the records of children G and H did not include complete information/documents.
13. Caregiver #1 confirmed that the above information was not included in the children's records.

Plan of Correction: A complete record will be obtained and maintained for all enrolled children including: child record form; proof of age/identity; results of a physical exam; immunization record; information for parents form; policy for the administration of medication form; liability insurance declaration form; and provisions of the home's emergency preparedness and response plan form. In the future, complete records will be obtained for all newly enrolled children.

Disclaimer:
A compliance history is in no way a rating for a facility.

The online compliance history includes only information after July 1, 2003. In addition, the online compliance history includes information regarding adverse actions that may be the subject of a pending appeal. An adverse action is not final until a provider has exhausted or waived all due process rights. For compliance history prior to July 1, 2003, or information regarding the status of pending adverse actions, please contact the Licensing Inspector listed in the facility's information. The Virginia Department of Social Services (VDSS) is not responsible for any errors in or omissions from the compliance history information.

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