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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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Ms. Maria Clark
1519 Moorman Avenue, NW
Roanoke, VA 24017
(540) 343-7810

Current Inspector: Rebecca Forestier (540) 309-2835

Inspection Date:

Complaint Related: No

Standard #: 22VAC40-111-800-B
Description: Based on review of the FDH's posted emergency plan, the Provider failed to document in writing at least annually each review and update to the emergency play. Evidence: The emergency plan was dated 12/2013 as the last reviewed date.

Plan of Correction: The Provider will review the plan and document the date of the review.

Standard #: 22VAC40-111-110-B
Description: Based on documentation reviewed, the Provider failed to ensure each received immunization record was signed by a licensed physician, the physician's designee, or an official of a local health department. Evidence: Documentation of the updated immunizations record for child #3 dated 02/2016 was not signed by a physician or other health care professional.

Plan of Correction: The Provider will request that the child's parent provide a copy which is signed by the health care professional. Documentation of a signed immunization record will be filed in the child's record.

Standard #: 22VAC40-111-60-B
Description: Based on a sample review of children's records, the Provider failed to ensure all required information was complete in each record. Evidence: Two of three reviewed children's records did not contain proof of the child's age and identify (children 1 & 2).

Plan of Correction: The Provider will review the records with the child's parent and will obtain the information to complete each record.

Standard #: 22VAC40-111-70-A
Description: Based on documentation reviewed in the sample review of children's records, the Provider failed to provide in writing to the parents the following information as required by this Standard: provisions of the family day home's emergency preparedness and response plan, medication policies and a liability insurance disclosure. Evidence: Information was not complete in two of three records reviewed (children 1 & 2): 1. the designated relocation site in the event a total evacuation of the FDH is required; 2. policies for the administration of medications; 3. whether or not there is liability insurance of at least $100,000 per occurrence and $300,000 aggregate in force on the family day home

Plan of Correction: The Provider will ensure that the information is complete and a copy given to parents. Signed verification will be filed in each child's record.

Standard #: 22VAC40-111-510-A
Description: Based on observations of the LI, the Provider failed to provide a cot or rest mat for a child for resting or napping. Evidence: The LI observed a child who is one month from turning three years old sleeping in an infant crib during nap time. The chid does not have any developmental delays which would necessitate the use of a crib.

Plan of Correction: The Provider will assign a rest mat for the child's use during nap time and will not use the crib for the child at any time.

Standard #: 22VAC40-111-690-D
Description: Based on the LI's observations, the Provider failed to ensure the diapering surface was maintained in a nonabsorbent manner. Evidence: Upon inspection, a small tear was observed on the pad of the diaper changing table.

Plan of Correction: The Provider will replace the changing pad.

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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