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(Under the authority of Executive Order 51, the Commissioner of Department of Social Services is waiving regulation 22VAC40-665-40.N which references the period of time for a redetermination of eligibility for the subsidy program. )

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Elisa Zewide
7900 Gunston Woods Place
Lorton, VA 22079
(703) 678-5044

Current Inspector: Tanya Johnson (571) 423-6392

Inspection Date: Dec. 7, 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 Physical Environment and Equipment
22VAC40-111 Preventing the Spread of Disease
22VAC40-111 Medication Administration
22VAC40-111 Emergencies
22VAC40-191 Background Checks for Child Welfare Agencies

An announced Initial inspection was conducted today. There are 4 children present (12 points) with 2 adults. 2 children's and 4 resident's files were reviewed. See violation notice for missing information. There are 4 cribs with manufacture dates that are acceptable. Please remove the additional crib until you are able to show it meets federal guidelines. Children were resting quietly during today's inspection. If you have any questions regarding this inspection, please contact me at 703-479-4678. LI was present today from 12:30 PM - 3:20 PM.

Standard #: 22VAC40-111-760-A-1
Description: Based upon a review of first aid supplies, the first aid kit is incomplete. Evidence: There is no operating digital thermometer in the kit.

Plan of Correction: I will purchase a new thermometer.

Standard #: 22VAC40-111-770
Description: There is no weather band radio available.

Plan of Correction: I will purchase a weather band radio.

Standard #: 22VAC40-111-60-B
Description: Based upon a review of files, children's files do not contain all required information. Evidence: Children's files are missing complete emergency contact information and parents complete work address. (Child 1 ,2)

Plan of Correction: I will have the parents complete the model forms that include all required information.

Standard #: 22VAC40-111-70-A
Description: Based upon a review of files, children's files do not contain all required policy notifications for parents. Evidence: Missing policy information includes but is not limited to: Decision to Administer medication, liability insurance declarations, pet disclosure, DSS web site address.

Plan of Correction: I will use the model forms provided that contain all required information.

Standard #: 22VAC40-111-90-C
Description: Based upon a review of files, one immunization record is incomplete. Evidence: Child 1's immunization record is not signed, stamped or electronically signed by the physicians office.

Plan of Correction: I will ask the parent to provide a new shot record.

Standard #: 22VAC40-111-240-B
Description: There is one crib assembled for use that does not have an acceptable manufacture date. The crib is not in use today. Evidence: The crib manufacture date for the crib is 2010.

Plan of Correction: The crib will be removed if I cannot get a certificate from the manufacturer saying it meets regulations.

Standard #: 22VAC40-191-40-C-1-a
Description: Based upon a review of files one resident file is incomplete. Evidence: Adult C does not have a completed Sworn Disclosure Statement (SDS) on file.

Plan of Correction: I will have the form signed today.

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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