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Laila Hussain
5800 Quantrell Avenue
Apt. 408
Alexandria, VA 22312
(703) 999-1860

Current Inspector: Stacy Doyle (571) 835-0386

Inspection Date: June 27, 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.

Technical Assistance:
-Discussed the inspection process with the provider and the assistant -Reviewed model forms with the provider (Child's Record Form, Emergency Preparedness and Response Plan, Information for Parents form, Liability Insurance form, Medication Policy form and Provisions of the Emergency Preparedness and Response Plan) -Discussed all information that is required for children's records

Comments:
An announced initial inspection was conducted today from 9:10am-10:45am. There were 2 children (4 points) directly supervised by 2 staff. The home, 2 staff records, 2 children?s records, 1 household member?s record, evacuation drills, emergency supplies, and policies were inspected. There were no medications on site today. The children were observed playing freely. 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 #: 22VAC40-111-800-A
Description: Based on record review, the provider did not have a written emergency preparedness and response plan for the home. Evidence: An emergency preparedness and response plan was not observed documented for the home.

Plan of Correction: I will complete the plan.

Standard #: 22VAC40-111-890
Description: Based on direct observation, children's food items brought from home were not clearly labeled in a way that identifies the owner. Evidence: A child's cup observed on the kitchen counter was not labeled with the child's name.

Plan of Correction: The cup was labeled during the inspection.

Standard #: 22VAC40-111-100-A
Description: Based on record review, the provider did not obtain documentation of a child's physical examination prior to the child's attendance or within 30 days after the first day of attendance. Evidence: Documentation of a physical examination was not observed for Child 2.

Plan of Correction: I will give mom the paper today.

Standard #: 22VAC40-111-60-B
Description: Based on record review, children's records were incomplete. Evidence: 1. The parent's address and phone number were not observed documented for Child 1. 2. The parent's work information was not observed documented for Child 1 and Child 2. 3. 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 Medications" form and the "Provisions of the Emergency Preparedness and Response Plan " form were not observed documented for Child 1 and Child 2. 4. Verification of the child's age and identity was not observed documented for Child 1 and Child 2.

Plan of Correction: I will start today.

Standard #: 22VAC40-111-320-B
Description: Based on direct observation, child-resistant protective covers were not installed on all unused electrical outlets. Evidence: Several outlets in the kitchen were observed without protective covers.

Plan of Correction: The outlets were covered during the inspection.

Standard #: 22VAC40-191-40-D-4-a
Description: Based on record review, the provider did not obtain a sworn statement or affirmation for an adult household member. Evidence: A sworn statement or affirmation was not observed documented for Household Member C.

Plan of Correction: The form was completed and signed during the inspection.

Standard #: 22VAC40-191-60-B
Description: Based on record review, the provider did not obtain a sworn statement or affirmation for caregivers. Evidence: A sworn statement or affirmation was not observed documented for Caregiver A and Caregiver B.

Plan of Correction: The form was completed and signed during the inspection.

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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