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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: May 20, 2019

Complaint Related: No

Areas Reviewed:
22VAC40-111 Administration
22VAC40-111 Personnel
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.
22VAC40-191 Background Checks for Child Welfare Agencies
63.2 Child abuse and neglect

Technical Assistance:
Technical assistance was offered regarding maintaining complete records for caregivers and children, electrical outlets, and use of age appropriate equipment for children. Various forms for children's and caregiver records were printed and provided to the provider to help maintain complete records.

Comments:
An unannounced renewal inspection was conducted from 10:05am to 12:10pm. There were 6 children (12 points) in care of 2 caregivers. The children were observed in circle time, playing with a large variety of toys, eating morning snack and playing outside with tricycles and a water table. 6 children's records and 1 caregiver record was reviewed. There were no medications on site. The evacuation drill log was current. 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 #: 22VAC40-111-110-B
Description: Based on record review, reports of immunizations for children were not signed or stamped by a licensed physician, the physician's designee, or an official of a local health department. Evidence: Child # 3, Child # 4 and Child # 5's immunizations were print outs provided by parents that were not signed or stamped by a physician.

Plan of Correction: I will request parents to submit immunization records that are signed or stamped.

Standard #: 22VAC40-111-120-B
Description: Based on record review, assistant's record did not contain all the required information. Evidence: 1. Caregiver # 1's record did not have documentation of two references. The provider stated that she did not know that reference checks had to be done. 2. Caregiver # 1's record did not have an emergency contact person listed.

Plan of Correction: I will complete the reference checks and file, and ask the care giver to provide information for an emergency contact.

Standard #: 22VAC40-111-60-B
Description: Based on record review, children's records did not contain complete information. Evidence: 1. Child # 1's record was missing information for persons authorized to pick up. 2. Child # 5's record was missing the medical insurance policy number and one emergency contact information.

Plan of Correction: I will have the forms completed and placed with each child's record.

Standard #: 22VAC40-111-70-A
Description: Based on records review, the provider did not provide the parents in writing the family day home's medication policy and liability insurance policy. Evidence: 1. Child # 1, Child # 2, Child # 3, Child # 4, Child # 5 and Child # 6's records did not have the family day home's written medication policy form. 2. Child # 1, Child # 2, Child # 3, Child # 4, Child # 5 and Child # 6's records did not have the family day home's written liability insurance policy.

Plan of Correction: I will provide this information to the parents as soon as possible.

Standard #: 22VAC40-111-80-A
Description: Based on record review, the provider did not verify the identity and age of the child within 7 business days. Evidence: Child # 6's record first date of enrollment was 3/71/9. There was no documentation available to demonstrate that the provider verified the child's identity, age and date of birth. The provider stated that the identification was checked in March 2019 but did not document it.

Plan of Correction: I will ask the parents to bring in a proof of identification.

Standard #: 22VAC40-111-200-C
Description: Based on record review, the provider did not maintain documentation of orientation for an assistant. Evidence: The provider stated that she completed a verbal orientation with Caregiver # 1 in March 2019, but did not complete written documentation of the orientation.

Plan of Correction: I will complete the form and place with 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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