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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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Debra Goodman
13565 Melville Lane
Chantilly, VA 20151
(703) 631-2044

Current Inspector: Karen Dickens (571) 423-6978

Inspection Date: May 3, 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 Emergencies
22VAC40-111 Nutrition
63.2 Facilities and Programs..
63.2 Liability Insurance Disclosure
22VAC40-191 Background Checks for Child Welfare Agencies

An unannounced monitoring inspection was initiated today at 3:00pm. The physical plant, 3 caregiver/household member files, 4 children's files, caregiver training, child nutrition, children's activities, emergency procedures, drills and supplies were inspected today. There were 8 children, totaling 17 points, under the supervision of 3 caregivers. During the inspection, children were observed finishing afternoon snack and playing outside. The interactions between the children and caregivers were seen to be positive and constructive in nature. Today, the children were served chicken nuggets, macaroni and cheese, peas, pears and milk. The Provider is not currently certified in MAT (medication administration training), but is looking to become certified soon. There are no children with any medication needs at this time. The caregivers are certified in CPR and First Aid. Should you have any questions, please contact me at

Standard #: 22VAC40-111-800-C
Description: Based on file review, caregiver #1 does not have documentation of having received training regarding the emergency evacuation, emergency relocation, and shelter-in-place procedures by the end of his first week of assuming job responsibilities.

Plan of Correction: The Provider will have this completed and documented.

Standard #: 22VAC40-111-830-B
Description: Based on file review, there is no documentation that shelter-in-place procedures were practiced a minimum of twice per year in 2015.

Plan of Correction: These will be completed and documented in 2016.

Standard #: 22VAC40-111-920
Description: Based on observation and interview, there is no posted menu of meals and snacks provided by the family day home.

Plan of Correction: The Provider will post this.

Standard #: 22VAC40-111-100-A
Description: Based on file review, 3 out of 4 children's files do not have documentation of a physical examination within 30 days after the first day of attendance. Evidence 1. Children #1, #3 and #4 do not have physicals on file.

Plan of Correction: The Provider will ask the parent for this.

Standard #: 22VAC40-111-120-B
Description: Based on file review, a caregiver's record did not have all required paperwork. Evidence !. Caregiver/household member #3 does not have the following information on file: - Name address and telephone number of a person to be notified in an emergency. - Documentation that two or more references as to character and reputation as well as competency were checked before employment. - Orientation training

Plan of Correction: The Provider will get this completed and kept on file.

Standard #: 22VAC40-111-90-C
Description: Based on file review, 1 out of 4 children's files does not have updated immunization records once every six months for children up to 2 years old. Evidence 1. Child #4 is 4 years old. The most recent immunization record was when the child was 10 months old.

Plan of Correction: The Provider will ask the parent for this.

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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