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Clotilde Espinoza
4602 15th Street, N
Arlington, VA 22207
(703) 525-8862

Current Inspector: Tanya Johnson (571) 423-6392

Inspection Date: Aug. 26, 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 Physical Environment and Equipment
22VAC40-191 Background Checks for Child Welfare Agencies
63.2 Child abuse and neglect
63.2 Facilities and Programs

Comments:
A focused inspection on Children's records, caregiver's records and household members records was conducted today between 10:00 am and 1:00pm. All relevant records were reviewed. Areas of non-compliance were cited. If you have any questions, please contact me at Tanya.Johnson1@dss.virginia.gov or call me at 571.423.6392.

Violations:
Standard #: 22VAC40-111-100-A
Description: Based on a review of children's records, the provider failed to ensure that all children would have documentation of physicals by the 30th day of attendance. Evidence: Child # 7's record does not have documentation of a physical by the 30th day of attendance. First date of attendance 9/1/18, physical dated 10/22/19.

Plan of Correction: I will get from parent.

Standard #: 22VAC40-111-120-B
Description: Based on a review of caregiver records, the provider failed to ensure that caregiver records were maintained and up to date. Evidence: 1) Caregiver #2 and #3's records do not contain the date of employment, or emergency contacts.

Plan of Correction: I will find the dates they started working for me and I will have them get their emergency contact information.

Standard #: 22VAC40-111-60-A
Description: The provider failed to ensure that children's records were up to date for all children enrolled. Evidence: 1) Child #2's records were missing the name, address and telephone number of each custodial parent's place of employment; name, address and telephone number of two designated persons to contact in case of an emergency if the parent cannot be reached; names of persons other than the custodial parents who are authorized to pick up the child; name and policy number of the child's medical insurance, and medication form. 2) Child #4's record is missing the address of mother place of employment and the medical policy number. 3) Child #5's record is missing the names of persons other than the custodial parents who are authorized to pick up the child, the parent information form and the parent agreement. 4) Child # 6's record is missing the medical insurance policy number and the emergency plan. 5) Child # 7's record is missing the medical insurance policy number. 6) Child #8's record is missing verification of proof of ID.

Plan of Correction: I will get them from the parents and put in the files.

Standard #: 22VAC40-111-90-A
Description: Based on a review of children's files, the provided failed to ensure that all children had proof of immunizations by the first day of attendance. Evidence: Child #4, #7 and #8's records did not have documentation of immunizations on the first day of attendance.

Plan of Correction: I will get from parents and put in file.

Standard #: 22VAC40-111-200-A
Description: Based on a review of caregiver records, the provider failed to ensure that the assistants will have orientation by the end of their first week of assuming job responsibilities. Evidence: Caregiver #2 and #3 do not have any documentation of orientation in their records.

Plan of Correction: I have this form, I will look for it.

Standard #: 22VAC40-111-230-A
Description: Based on a review of caregiver records, the provider failed to ensure that caregivers will receive a minimum of 16 training hours each year. Evidence: Caregiver #1, #2 and #3 do not have any documentation of training in their records.

Plan of Correction: I will look for certificates.

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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