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Roina Mustafa
7702 Tanner Robert Court
Springfield, VA 22153
(703) 569-4084

Current Inspector: Anansa Archer-Hicks (703) 268-3295

Inspection Date: Jan. 11, 2018

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
22VAC40-111 Nighttime Care
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
54.1-3408 Provider must be MAT certified to administer prescription medication.

An unannounced monitoring inspection was conducted today from 11:00am-1:45pm. There were 11 children (36 points) directly supervised by 3 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 medications on site today. Children were observed playing freely, doing puzzles, napping, being bottle fed and eating lunch. Today's lunch consisted of chicken breast, rice, mixed vegetables, blueberries and milk. 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 the Violation Notice. If you have any questions regarding this inspection, please contact Maria Soto at 571-835-5058 or

Standard #: 22VAC40-111-830-C
Description: Based on review of emergency response drills record, the provider did not have documentation of shelter-in-place drills Evidence: There was no documentation of shelter-in-place drills being practiced two times a year.

Plan of Correction: I will document the shelter-in-place drills.

Standard #: 22VAC40-111-100-A
Description: Based on record review, the provider did not obtain documentation of a physical for a child prior to or within 30 days of first attendance. Evidence: Child#4 first day of attendance 5/1/2017, there was no documentation of a physical in the child's file

Plan of Correction: I have already talked to the parent to bring in the form.

Standard #: 22VAC40-111-90-C
Description: Based on review of 5 children's records, the provider did not obtain documentation of updated immunization once every six months for children under the age of two years. Evidence: Child#2 (DOB: 8/2/2016) their last immunization update was dated 6/22/2017, an update was required by 12/22/2017.

Plan of Correction: I will request a new immunization record from the parents.

Standard #: 22VAC40-191-60-C-1
Description: Based on staff record review, the provider did not obtain an original criminal history record report within 30 days of employment of a staff member. Evidence: Staff#1 hired on 11/15/2017, did not have documentation of a completed Criminal History Report form. The form was submitted in November but it was returned on 11/22/2017. A second request was made, but the provider does not have documentation of the second request being sent out to the agency.

Plan of Correction: I will call to find out what is the status of the form.

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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