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Ms. Mozhdeh Monjezi
1658 Old Brook Road
Charlottesville, VA 22901
(434) 409-6465

Current Inspector: Diann S. Reed (540) 280-0742

Inspection Date: Nov. 20, 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
22VAC40-80 THE LICENSE.
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.

Technical Assistance:
We discussed the requirements for outdoor equipment, records for children and proof of age/identity. The risk assessments for violations were provided. As a reminder, there should be twelve inches between occupied cribs. Sixteen hours of annual training is required.

Comments:
Thank you for your assistance during the unannounced monitoring inspection conducted from 11:20 AM and 3:25 PM. Today, there were twelve children (infants through age two/41 points) with three caregivers. I viewed daily routines, staffing, supervision, interactions with children, activities, equipment, posted information, emergency supplies and drill records, substitute provider record, five records for children, injury record, training for three caregivers, meals and snacks, indoor and outdoor areas. There was the use of a substitute provider due to the provider's need for a family trip. Three caregivers were observed providing attentive supervision, and responding to individual needs for care, comfort, guidance and feeding. There were opportunities for outside experiences and accessible play equipment. Infants were provided floor time and changes with the use of seating. Let me know if you have any questions. 540/430-9259

Violations:
Standard #: 22VAC40-111-840-B
Description: Based on a review of a record for treatment of a minor injury on June 23, 2015, and an interview with the caregivers, there was information missing from the report. Evidence: The description of the injury sustained and treated was not written on the report. A caregiver indicated the injury was a cut on the forehead. Also, the sections for documenting the date, time and method of parent notification were left blank.

Plan of Correction: The provider will have the known information about the description of the injury, and the date, method and time of parent notification added to the injury report. In the future, the provider and attending caregiver will read the reports before they are filed to make sure they include all required information.

Standard #: 22VAC40-111-100-A
Description: Based on a review of five records for children, and an interview with caregivers, the physical examination records for child 2 was obtained late, and not obtained within the first thirty days of attendance. There was not a physical examination record in the file for child 5. (Repeat violation.) Evidence: Child 2 began attending on August 25, 2015 and the immunization record was dated November 4, 2015. Child 5 has been in care since January 20, 2015 and there were only two immunization reports with the records. A health department form with a section for a physical examination report was blank.

Plan of Correction: The provider or a caregiver will request and obtain a copy of child 5's physical examination record. The provider will continue to emphasize the need for parents to provide signed physical examination reports for new children within the first month of attendance. The provider will use a reminder system for obtaining the records on time.

Standard #: 22VAC40-111-90-A
Description: Based on a review of five records for children, and an interview with caregivers, the immunization record for child 2 was obtained late, and not obtained before the child's first date of attendance. Evidence: Child 2 started on August 25, 2015 and the immunization record was dated November 4, 2015.

Plan of Correction: The provider will communicate with parents of new children about the need for a signed immunization record by the first date of attendance. If parents are not providing the record as requested, they will be asked to return only with the required health information.

Standard #: 22VAC40-111-500-C
Description: Based on observation, and measurement of the fall zones for the outdoor slides, there was less than six feet between the perimeter of equipment and other obstacles. Evidence: There was only five feet and six inches between the orange slide exit and the patio. Also, a buried and exposed board was two feet, two inches from the same slide. The blue steps were four feet from the fence. The pink slide exit was five feet from the patio. The yellow steps were five feet and six inches from the fence.

Plan of Correction: A family member removed one of the slides from the play area and arrange the orange slide with blue steps so that it was six feet from obstacles. The buried board was covered with extra shredded rubber surfacing. The caregivers will make sure children play on equipment that has a six foot fall zones from the perimeter of equipment and any obstacles and hard surfaces.

Standard #: 63.2-1809-A
Description: Based on a review of five records for children, and an interview with caregivers, the proof of the identity and age of child 2 was with an unacceptable document. Evidence: There was a copy of child 2's social security card. There was not a birth document or passport provided within seven business days of attendance.

Plan of Correction: The provider or a caregiver will view a birth letter or birth certificate. If the required proof of age and identity is not provided within seven business days, the provider will contact the appropriate law enforcement agency to report the lack of proof.

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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