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Hilda Bustamante
1531 Coat Ridge Rd.
Herndon, VA 20170
(703) 657-0317

Current Inspector: Maria Soto (571) 835-5058

Inspection Date: Sept. 6, 2017

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 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 the following with the Provider: -location of cribs and cots for rest/naptime -procedures when changes to the menu may be made -procedures in the diapering process

Comments:
An unannounced renewal inspection was initiated today at 10:00am. The inspection was completed by Licensing Inspectors, Mary Wizbicki and Maria Soto. The physical plant, 5 caregiver/household member files, 5 children's files, caregiver training, child nutrition, children's activities, emergency procedures, drills and supplies were inspected today. There were 11 children, totaling 33 points, under the supervision of 3 caregivers. During the inspection, children were observed putting together puzzles, working with letters, enjoying free play, listening to story time and eating lunch (infants). The interactions between the children and caregivers were seen to be positive and constructive in nature. Today, the children were served chicken nuggets, peas, carrots, rice and milk. The Provider is currently certified in MAT (medication administration training), CPR and First Aid. There are no children with any medication needs at this time. Should you have any questions, please contact me at mary.wizbicki@dss.virginia.gov.

Violations:
Standard #: 22VAC40-111-940-B
Description: Based upon observation, the temperature of the refrigerator was found to be above the required level of 40 degrees. Evidence: 1. The thermometer in the refrigerator was reading 44 degrees.

Plan of Correction: Provider will defrost the freezer over the weekend.

Standard #: 22VAC40-111-940-C
Description: Based on observations, there were drinks not kept in the refrigerator. They were not being prepared or served. Evidence 1. At approximately 10:30am, there were sippy cups filled with milk sitting out on the counter. When asked when the children would be consuming these, the Provider stated they would be served with lunch around noon.

Plan of Correction: Corrected during the inspection.

Standard #: 22VAC40-111-120-B
Description: Based on file review, 2 out of 2 assistant records do not have all required information. Evidence 1. Caregiver #2 does not have documentation of when she began employment at the FDH. 2. Caregiver #3 does not have documentation that two or more references as to character and reputation as well as competency were checked before employment began.

Plan of Correction: I will obtain reference checks, and I will include the start date of employment to her employment forms.

Standard #: 22VAC40-111-50-C
Description: Based on observation, there was information of children in care which was not kept in a confidential manner. Evidence 1. On the bulletin board in the stairway to the basement play area, there was a sheet of paper which listed children, parents and their contact information.

Plan of Correction: Provider will remove it from the bulletin board.

Standard #: 22VAC40-111-60-B
Description: Based on record review, 2 out of 5 files did not have a policy number of the child's medical insurance. Evidence: 1. Child#1 does not have documentation of an insurance policy number. Child#5 does not have documentation of an insurance company or policy number. 2. Child #3 does not have documentation of 1 out of 2 emergency contacts.

Plan of Correction: Provider will ask the parents to provide the information, so that she can add it to the children's records.

Standard #: 22VAC40-111-210-A
Description: Based on file review, 2 out of 3 caregivers do not have documentation of having attended a minimum of 16 hours of annual training. Evidence 1. Caregiver #1 has only 14.5 hours of training in 2016. 2. Caregiver #2 has only 2.5 hours of training in 2016.

Plan of Correction: We'll meet the 16 training hours.

Standard #: 22VAC40-191-40-D-1-b
Description: Based on file review and interview, 1 out of 3 caregiver files does not have a completed criminal history record check (CRC) or sworn disclosure statement (SDS) completed before 30 days of employment at the facility ends. Evidence 1. The Provider stated that caregiver #2 began caring for children at the FDH on March 2017. There is no completed CRC on file. Caregiver #2 has a SDS on file, but there is no signature on the form.

Plan of Correction: Provider will submit background forms needed and caregiver#2 will be unable to work until the completed CRC is received. Provider will email the inspector when it's completed.

Standard #: 22VAC40-191-40-D-1-c
Description: Based on file review, 1 out of 5 caregiver/household members does not have background checks completed before three years since the last checks were done. Evidence 1. Caregiver #3's most recent search of the central registry was completed on 7/22/14.

Plan of Correction: This form was sent to be completed on 8/28/17. The Provider is waiting for the results.

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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