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Fatemeh Ranjbarkohan
745 Bonnie Ridge Drive, NE.
Leesburg, VA 20176
(703) 729-0899

Current Inspector: Maria Robles-Lopez (703) 397-3827

Inspection Date: Oct. 26, 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 Medication Administration
22VAC40-111 Emergencies
22VAC40-111 Nutrition
22VAC40-80 THE LICENSE.
22VAC40-80 THE LICENSING PROCESS.
63.2 Child Abuse and Neglect
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:
Discussion was held on the topics of current enrollment, current staffing, the new definition of a serious injury, and a review of changes to background checks with regards to expiration dates, new sworn disclosure statements, and to obtain CPS checks from other states as listed from the past five years.

Comments:
The following inspection took place between the hours of 10 am through 1 pm. Today, I met with the Provider on site at the Family Day Home (FDH) located near Ashburn, Virginia. At the start of this unannounced monitoring inspection there were a total of 8 children (22 points) with 2 caregivers. A total of 9 children?s files and 2 staff/household member?s files were reviewed. The children were engaged in the following: morning snack, movie time, toy play, music, games, learning, lunch, nap time, and other organized activities. If you should have any future questions, please call. Thank you. Charlie Perkins, Licensing Inspector (703) 309-3963

Violations:
Standard #: 22VAC40-111-780-B
Description: Based on review, 4 of 9 children's files reviewed indicated that the Provider did not review with the parent the emergency contact information (required in 22 VAC 40-111-60 B 2) to ensure the information is correct, and obtain annually the parent's signed acknowledgment of each year's review. Evidence - 1. On the date of inspection (10/26/2017), the following children had reviews that were older than one year: Child #2 (dated - 08/31/2016), Child #3 (dated - 08/31/2016), Child #4 (dated - 09/15/2016), and Child #6 (dated - 08/30/2016). 2. All other children's files reviewed, had current signatures: Child #1, Child #5, Child #7, Child #8, and Child #9.

Plan of Correction: All applicable files shall have updated review signatures.

Standard #: 22VAC40-111-100-A
Description: Based on review, 1 of 9 children's files reviewed indicated that the Provider did not obtain 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 - 1. On the date of inspection (10/26/2017), documentation of a physical examination for Child #1 was not available for review. 2. The start date for Child #1 was listed as 08/03/2017.

Plan of Correction: The guardian of Child #1 shall be contacted and a physical shall be obtained.

Standard #: 22VAC40-111-60-B
Description: Based on review, 1 of 9 children's files reviewed indicated that not all of the required information was contained within each child's record. Evidence - 1. On the date of inspection (10/26/2017), the proof of identification was not available for Child #1. 2. The start date for Child #1 was listed as 08/03/2017.

Plan of Correction: The guardian for Child #1 shall be asked to provide proof of identification for proper review.

Standard #: 22VAC40-111-90-C
Description: Based on review, 1 of 9 children's files reviewed indicated that the Family Day Home (FDH) did not obtain documentation of additional immunizations for a child (who was not exempt from the immunization requirements according to subsection B of this section) once every six months for children under the age of two years. Evidence - 1. On the date of inspection (10/26/2017), the most current immunization page on file for Child #6 was dated - 10/26/2016. 2. On the date of inspection, based on the information on file, Child #6 was under 2 years of age.

Plan of Correction: An updated immunization page shall be obtained for Child #6.

Standard #: 22VAC40-111-180-A
Description: Based on review, 1 of 2 staff/household member's files reviewed indicated that the Provider did not obtain for each caregiver and adult household member a current Report of Tuberculosis Screening (TB) form (in accordance with the requirements in 22 VAC 40-111-170), every two years from the date of the most current documentation. Evidence - 1. On the date of inspection (10/26/2017), the most current TB documentation on file at the FDH for Member #2 was dated - 10/13/2015. 2. This was confirmed on the date of inspection by Member #2.

Plan of Correction: Updated documentation shall be obtained and placed on file.

Standard #: 63.2-1809.1-B
Description: Based on review, 1 of 9 children's files reviewed indicated that each parent or guardian did not acknowledge, in writing, the receipt of the notice of Liability Insurance Declaration form. Evidence - 1. On the date of inspection (10/26/2017), a sign acknowledgement notice of Liability Insurance Declaration for Child #1 from the Family Day Home (FDH) was not available for review. 2. This form was not on file.

Plan of Correction: This signed form shall be obtained and placed on file.

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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