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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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Masomeh Azadi
10249 Leesburg Pike
Vienna, VA 22182
(703) 430-0222

Current Inspector: Cynthia Ford (703) 479-4679

Inspection Date: Dec. 19, 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
22VAC40-111 Transportation
63.2 General Provisions.
63.2 Licensure and Registration Procedures
63.2 Facilities and Programs..
63.2 Liability Insurance Disclosure
22VAC40-191 Background Checks for Child Welfare Agencies

Technical Assistance:
**Discussed with the provider that she needed to complete 2 shelter-in-place drills prior to the end of December, to remain in compliance with the standards.

An unannounced monitoring/renewal inspection was conducted today at 1:20pm. There were 5 children (18 points) directly supervised by 1 staff. The home, 2 staff records, 5 children?s records, 1 household member?s records, evacuation drills, emergency supplies, and policies were inspected. There were no childcare children's medications on site today. Children were observed napping, waking up from nap and playing freely. Diapering procedures were also observed. There was an abundant supply of books, toys, and materials for the children. The home was clean and organized. Areas of non-compliance are identified in this report. Please sign and date all reports and return it to me within 10 calendar days from today. If you have any questions regarding this inspection, please contact the Licensing Inspector. Keesha Minor ( (703)479-4680

Standard #: 22VAC40-111-760-A-1
Description: Based on observation, the provider failed to ensure that the first aid kit contained the minimum items as required. Evidence: Observed that there was no first aid instructional manual in the first aid kit.

Plan of Correction: As soon as my assistant returns I will get from upstairs.

Standard #: 22VAC40-111-800-B
Description: Based on review, the provider failed to ensure that the emergency preparedness plan is reviewed at least annually and updated as needed. Evidence: Reviewed the emergency preparedness plan and found that it was last reviewed/updated on 6/24/2015.

Plan of Correction: Today I am going to updated.

Standard #: 22VAC40-111-100-A
Description: Based on observation, the facility failed to ensure that they obtained documentation of a physical examination by or under the direction of a physician prior to a child's attendance or within 30 days after the first day of attendance. Evidence: Observed that CH3 and CH4 did not have documentation of a physical examination.

Plan of Correction: Will give deadline for end of the week.

Standard #: 22VAC40-111-60-B
Description: Based on review, the facility failed to ensure that children's records are maintained with the required information. Evidence: Reviewed 5 children's records and found that... 1) CH1 did not have documentation of an emergency contact. 2) CH3 did not have documentation of a second emergency contact. 3) CH1 did not have documentation of a dated emergency contact form. 4) CH1 did not have documentation of an authorized emergency contact form.

Plan of Correction: I am going to ask for emergency contact today. Will give deadline for end of week.

Standard #: 22VAC40-111-570-A
Description: Based on observation, the provider failed to ensure that each caregiver does not exceed 16 points, following the point system to determine if an additional caregiver is needed. Evidence: Observed that there was 1 caregiver with 5 children in care, with a total of 18 points. The assistant was not on site at the time of the inspection.

Plan of Correction: Assistant had to leave momentarily but will come back.

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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