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Marites Silvestre
2423 Cedar Lane
Vienna, VA 22180
(703) 901-5496

Current Inspector: Maria Soto (571) 835-5058

Inspection Date: April 10, 2019

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
22VAC40-191 Background Checks for Child Welfare Agencies
54.1-3408 Provider must be MAT certified to administer prescription medication.
63.2 Child abuse and neglect
63.2 Licensure and Registration Procedures
63.2 Facilities and Programs

Technical Assistance:
Discussed unannounced 60 day visit.

Comments:
An announced initial inspection was conducted today to determine compliance with licensing standards. The inspection was initiated at 10:00am and concluded at 12:00pm. There were 3 children (12 points) directly supervised by 2 staff. The home, 2 staff records, 3 children?s records, 3 household member?s records, evacuation drills, emergency supplies, and policies were inspected. There were no medications on site today. Children were observed playing freely, playing with blocks, and eating lunch. Today's lunch consisted of chicken Teriyaki, mixed vegetables, steamed rice and milk. The home was found to be clean and organized, and well supplied with toys and equipment for the children. A recommendation will be made for the issuance of a six month Conditional License. Questions about this inspection may be directed to maria.soto@dss.virginia.gov.

Violations:
Standard #: 22VAC40-111-100-A
Description: Based on record review, the provider did not obtain documentation of a physical examination by or under the direction of a physician within 30 days of the child's first day of attendance. Evidence: The records of child#1, #2 and #3 did not contain documentation of a physical examination. Child#1's first day of attendance was documented as 3/4/2019. Child#2's first day of attendance was documented as 8/27/2018. Child#3's first day of attendance was documented as 10/13/2018.

Plan of Correction: I will send the form to the parents tonight, to get it completed this week.

Standard #: 22VAC40-111-60-B
Description: Based on record review, children's records were incomplete. Evidence: Child#3's record is missing the address for one emergency contact.

Plan of Correction: I will ask for an address for the second emergency contact.

Standard #: 22VAC40-191-40-C-1-a
Description: Based on record review and interview, the provider did not complete a sworn statement of affirmation form. Evidence: The applicant did not have a completed sworn disclosure or affirmation form during the inspection.

Plan of Correction: I will complete the form.

Standard #: 22VAC40-191-40-C-1-c
Description: Based on record review and interview, the provider did not obtain a central registry report for each household member and a sworn statement of affirmation form for each household member was not completed. Evidence: Household member#1's record does not contain a central registry result and a completed sworn statement or affirmation form. Household member#2's record does not contain a central registry result. The records of Household member#3 and #4 do not contain completed sworn statement or affirmation forms.

Plan of Correction: The central registry form were submitted, we are waiting for results. The sworn disclosure or affirmation form will be completed.

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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