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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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Maria Perea-Gonzales
6118 Yellowstone Drive
Alexandria, VA 22312
(540) 259-5036

Current Inspector: Nancy Radcliffe

Inspection Date: April 21, 2016

Complaint Related: No

Areas Reviewed:
22VAC40-111 Administration
22VAC40-111 Personnel
22VAC40-111 Household Members
22VAC40-111 Physical Environment and Equipment
22VAC40-111 Care of Children
22VAC40-111 Preventing the Spread of Disease
22VAC40-111 Emergencies
22VAC40-111 Nutrition
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:
Discussed with Provider: I cannot submit your application for approval until the completed, original, background search documents have been reviewed.

AN announced Initial inspection was conducted today. There are 4 children (11 points) with one caregiver. 2 adult and 4 children's files were reviewed. See violation notice for missing information. Children are resting and playing quietly during today's inspection. Please contact me once your original documents have arrived so that I can review them. If you have any questions regarding this inspection, please contact me at 703-479-4678. LI was present today from 12:05 PM - 1:15 PM

Standard #: 22VAC40-111-60-B
Description: Based upon a review of files, children's files are incomplete. Evidence: 2 of 4 files reviewed were missing documentation of complete health insurance information. (Children 2, 3)

Plan of Correction: I will ask the parent to bring the information to complete the file.

Standard #: 22VAC40-111-70-A
Description: Based upon a review of files, parents have not been provided with complete policies as required. Evidence: 4 of 4 file reviewed do not contain documentation of the policy for termination of care. ( Children 1,2,3,4)

Plan of Correction: I will correct the form and have the parents initial the forms.

Standard #: 22VAC40-191-40-C-1-a
Description: Based upon a review of files, adult files are incomplete. Evidence: Adult A does not have a completed Criminal Record Check (CRC) on file. The form was returned for additional information, and has not yet been returned from the state police. Adult B does not have a completed Child Protective Services Search (CPS) on file.

Plan of Correction: I will contact Richmond to find out where the CRC results are, and a CPS form will be submitted for the person needing it.

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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