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Gita Kumar
5642 Powers Lane
Centreville, VA 20120
(703) 266-0223

Current Inspector: Nancy Radcliffe

Inspection Date: March 22, 2016

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
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 unannounced renewal inspection was conducted today from 9:15am-10:15am. There were 7 children(15 points) directly supervised by 3 staff. The home, 3 staff records, 4 children?s records, evacuation drills, emergency supplies, and policies were inspected. There were no medications on site today. Children were observed coloring and playing independently. The home was clean and organized. Areas of non-compliance are identified in the Violation Notice. If you have any questions regarding this inspection, please contact the Licensing Inspector, Erika Gibson at erika.gibson@dss.virginia.gov or 703-479-4686.

Violations:
Standard #: 22VAC40-111-110-B
Description: Based on record review, a child's physical examination report was not signed by a licensed physician, the physician's designee, or an official of a local health department. Evidence: The physical examination report observed for Child 4 was not signed by the physician.

Plan of Correction: It will be corrected.

Standard #: 22VAC40-111-60-B
Description: Based on record review, children's records were incomplete. Evidence: 1. The father's work address and phone number were not observed documented for Child 1. 2. The medical insurance policy number and the parent's signed acknowledgement of the receipt of the "Information for Parents" form, the "Liability Insurance Declaration" form, the "Policy for the Administration of Medication" form and the "Emergency Preparedness and Response Plan" form were not observed documented for Child 4.

Plan of Correction: I will give the forms today.

Standard #: 22VAC40-191-40-D-1-b
Description: Based on record review, the provider did not obtain a current criminal history record check within 30 days of employment for a caregiver. Evidence: Documentation of a criminal history record check was not observed for Caregiver C.

Plan of Correction: The form will be sent.

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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