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Nozomi Hoshi
12408 Wendell Holmes Road
Herndon, VA 20171
(703) 254-4418

Current Inspector: Mahrukh Aziz (571) 835-4718

Inspection Date: March 7, 2019

Complaint Related: No

Areas Reviewed:
22VAC40-111 Administration
22VAC40-111 Personnel
22VAC40-111 Physical Health of Caregivers and Household Members
22VAC40-111 Physical Environment and Equipment
22VAC40-111 Care of Children
22VAC40-111 Preventing the Spread of Disease
22VAC40-111 Nutrition
22VAC40-80 THE LICENSE.
22VAC40-191 Background Checks for Child Welfare Agencies
63.2 Licensure and Registration Procedures
63.2 Facilities and Programs

Technical Assistance:
Technical Assistance was offered for the following: Menu, appropriate materials for children, emergency drills, and record keeping.

Comments:
An unannounced non mandated inspection was conducted from 10:20am to 12:30pm, to assess the compliance of standards at the family day home. There were 7 children (14 points) present with two caregivers. The children were observed eating morning snack which included tortilla chips, crackers and apples, singing songs, listening to stories, coloring and playing with home living toys. Children were observed washing hands before eating snack. 6 children's records were reviewed. There were no medications on site. Areas of non compliance are listed in the Violation Notice. For any questions regarding this inspection, please contact me at 571-835-4718 or mahrukh.aziz@dss.virginia.gov.

Violations:
Standard #: 22VAC40-111-120-A
Description: Based on record review and staff interview, the provider did not maintain a record for each caregiver. Evidence: 1. Caregiver # 2 stated that she started to volunteer at the family day home on 3/4/19. Staff # 2 stated that she may consider employment at the family day home. 2. Caregiver # 1 stated that she did not obtain any information for Caregiver # 2's record. 3. There were no documents to verify Caregiver # 2's name, address, date of employment, emergency contact information, reference checks, background checks and a tuberculosis screening.

Plan of Correction: If caregiver # 2 accepts the position I will get her complete paperwork.

Standard #: 22VAC40-111-50-A
Description: Based on record review, the provider did not maintain a written record of children's daily attendance. Evidence: Caregiver # 1 showed the inspector a sheet that she stated was children's attendance. The attendance was documented in a different language and compliance could not be determined.

Plan of Correction: I will document the attendance in English.

Standard #: 22VAC40-111-60-A
Description: Based on record review and staff interview, the provider did not maintain an up to date record for each child enrolled. Evidence: 1. There were 7 children present at the family day home. 2. A complete record was not maintained by the provider for Child (CH) # 1 and was not available for review. 3. Records for CH # 2, CH # 3, CH # 4, CH # 5, CH # 6 and CH # 7 were documented in another language and the inspector could not determine compliance.

Plan of Correction: I will collect all the forms and information in English and maintain a complete record for the children.

Standard #: 22VAC40-111-90-C
Description: Based on record review and staff interview, the provider did not obtain immunization records for a child in care by the first day of enrollment. Evidence: Caregiver # 1 stated that Child # 1's first day of attendance was 2/12/19. Child # 1's immunization records were not obtained by the provider and were not available for review.

Plan of Correction: I will ask the parents to bring in the record.

Standard #: 22VAC40-111-170-A
Description: Based on staff interview, the provider did not obtain a current report of tuberculosis (TB) screening for each caregiver, before coming into contact with the children. Evidence: Caregiver # 2 stated that she started volunteering at the family day home on 3/4/19. Caregiver # 1 stated that she did not obtain a negative TB wscreening for Staff # 2.

Plan of Correction: If caregiver # 2 accepts the position I will get her TB test results.

Standard #: 22VAC40-111-280
Description: Based on observation, potentially poisonous materials were not inaccessible to children. Evidence: 1. After the morning snack, disinfectant wipes were given to children to clean their faces and hands with. Two children were observed cleaning their hands and faces with the wipes. 2. The disinfectant wipes are intended to be used for disinfecting surfaces only. The label on the bottle stated that it should be kept out of reach of children.

Plan of Correction: I will not use these wipes for this purpose.

Standard #: 22VAC40-191-60-B
Description: Based on staff interview, the provider did not obtain a complete Sworn Disclosure Statement (SDS) from a volunteer at the family day home. Evidence: 1. Caregiver #2 stated that she started to volunteer at the family day home on 3/4/19. 2. Caregiver # 1 did not obtain a complete SDS for Caregiver # 2 and it was not available for review. 3. Caregiver # 2 was observed supervising and interacting with the children during the inspection.

Plan of Correction: If Caregiver # 2 gets employed at the family day home, I will have her complete the form and keep in her record.

Standard #: 63.2-1720.1-B-2
Description: Based on staff interview, a caregiver at the family day home did not submit fingerprint results before the first day of employment. Evidence: 1. Caregiver #2 stated that she started to volunteer at the family day home on 3/4/19. 2. Caregiver # 1 did not obtain fingerprint results for Caregiver # 2 before the first day of employment. 3. Caregiver # 2 was observed supervising and interacting with the children during the inspection.

Plan of Correction: If Caregiver # 2 gets employed at the family day home I will get her fingerprint results and keep in her record.

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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