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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: June 8, 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 Liability Insurance Disclosure
22VAC40-191 Background Checks for Child Welfare Agencies

Technical Assistance:
Consultation was given on the importance of demonstrating compliance during the conditional license period and how repeat violations can impact issuing a new license. The Provider will need to attend Phase II for Family Day Home Providers on June 28, 2016 before consideration will be given on issuing a one year license. The provider was reminded of safe heating procedures for milk for children and the procedures to employ an assistant. The provider was e-mailed several VA DSS model forms during the inspection.

An unannounced renewal visit was conducted today. The inspector was on site from 11:20am-12:50pm. Four children were in care with one caregiver for 8 points which is within ratios for supervision. Children were observed in free play, preparation for lunch as well as engaging in peer interactions. Emergency preparation, physical space, records for children and nutrition were reviewed. Areas of non-compliance are identified in this report. Please sign and date the report and return it to me within 10 calendar days from date of receipt. If you have any questions regarding the inspection, please feel free to contact me. The Provider's responses were not received as of 6/27/2016 and will not appear on the Violation Notice. Thank you Ann Dramstad Licensing Inspector 703-314-0860

Standard #: 22VAC40-111-890
Description: Based on observation, the food bought form the child's home is not labeled. Evidence: Lunches were not labeled with the child's name for identification by the provider.

Plan of Correction: I will ensure all food that is supplied by parents is labeled.

Standard #: 22VAC40-111-900-B
Description: Based on observation, children were allowed to walk around while drinking and/or eating. Evidence: Child #3 was observed playing and walking around the play area with a sippy cup of milk. Child #4 was observed eating a fruit pouch while playing with toys.

Plan of Correction: When the Licensing Inspector reminded the provider that children should not walk around with food or drink she had both children sit down.

Standard #: 22VAC40-111-50-A
Description: Based on documentation reviewed, the provider did not accurately complete the daily attendance. Evidence: The provider did have a posted attendance sheet, however, children's names were filled out in advance for the entire week and did not accurately reflect who was present at the Family Day Home.

Plan of Correction: I will start to use the attendance form correctly.

Standard #: 22VAC40-111-60-B
Description: Based on record review, two children?s files were incomplete. Evidence: 1. Child #1 was missing the address for his emergency contact and the insurance policy number. 2. Child #2 was missing the provider?s signature documenting proof of identification, parent signature for emergency medical authorization and the authorization to administer medication form.

Plan of Correction: I will have parents provide the missing information. The provider signed the proof of identity form during the inspection.

Standard #: 22VAC40-111-70-A
Description: Based on record review, the written "Information For Parents" form with parent acknowledgement was not present in the child's file. Evidence: Child #2 did not have a signed copy of the Information For Parent form acknowledging receipt of the policies and procedures for the Family Day Home.

Plan of Correction: I will provide parents with information and obtain signatures.

Standard #: 22VAC40-111-240-A
Description: Based on direct observation, areas of the home were not maintained in an operable manner. Evidence: 1. The first step leading to the entrance of the FDH area was deteriorating. 2. An outside light bulb was exposed as the protective globe was missing

Plan of Correction: I will fix the deteriorating step and replace the missing globe.

Standard #: 22VAC40-111-280
Description: Based on direct observation, hazardous materials were accessible to children. Evidence: 1. Bleach was stored in a lower cabinet used by children.

Plan of Correction: The provider moved the bleach to a locked closet during the inspection.

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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