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Hilda Bustamante
1531 Coat Ridge Rd.
Herndon, VA 20170
(703) 409-8222

Current Inspector: Maria Soto (571) 835-5058

Inspection Date: Aug. 14, 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 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

Comments:
An unannounced renewal inspection was conducted today from 11:30am-2:00pm. There were 10 children (26 points) directly supervised by 3 staff. The home, 3 staff records, 5 children?s records, 3 household member?s records, evacuation drills, emergency supplies, and policies were inspected. Children were observed playing freely, engaging in water activities, and playing outdoors. Diapering procedures were also observed. 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 on the Violation Notice.

If you have any questions regarding this inspection, please contact Maria Soto at 571-835-5058 or maria.soto@dss.virginia.gov

Violations:
Standard #: 22VAC40-111-700-A
Description: Based on record review and review of medication, the provider did not have a written medication authorization from the child's physician and their parent for long term prescription medication.

Evidence:
Child#2 has a long term medication on-site without a medication authorization form completed and signed by the parent and the child's physician.

Plan of Correction: The medication form is going to be signed.

Standard #: 22VAC40-111-50-B
Description:

Plan of Correction: The records are available already.

Standard #: 22VAC40-111-60-B
Description: Based on record review, children's record were incomplete.

Evidence:
Child#1's record is missing the parents' work telephone number and their work address, the child's medical insurance policy number, and the telephone number for 1 of 2 required emergency contacts.

Plan of Correction: They signed and return before 8/29/2019. [SIC]

Standard #: 22VAC40-111-90-A
Description: Based on record review, the provider did not obtain documentation that each child was adequately immunized before their first day of attendance.

Evidence:
The records of Child#1, #4 and #5 did not contain documentation of immunization records. All three children were in attendance during the inspection.

Plan of Correction: Records for Child#1 is going to be on September 5th. Child#4 and Child#5 September 9th. [SIC]

Standard #: 22VAC40-111-170-A
Description: Based on record review, the provider did not obtain a tuberculosis (TB) test/screening for each caregiver at the time of hire or prior to coming into contact with children.

Evidence:
Staff#3's record does not contain a TB test/screening, the staff member was hired on 06/12/2019.

Plan of Correction: We all have appointments for the end of the month.

Standard #: 22VAC40-111-180-A
Description: Based on record review, the provider did not obtain a current report of tuberculosis screening/test for each household member/caregiver every two years from the date of the last test/screening.

Evidence:
Staff#1's record contains a TB test/screening that was last updated on 7/26/2017. HH#1's record contains a TB test/screening that was last updated on 7/26/2017. HH#2's record contains a TB test/screening that was last updated on 6/27/2017.

Plan of Correction: We all have to be ready after September 12. [SIC]

Standard #: 22VAC40-111-660-B
Description: ased on record review and interview, it was determined that the provider did not obtain a written authorization from the parent of each child to participate in swimming or wading activities.

Evidence:
During the inspection 8 children were observed on the provider's back porch in bathing suits, using a small portable wading pool containing approximately 3 inches of water. The provider did not have a signed authorization from parents allowing their children to participate in water activities.

Plan of Correction: The parents is going to signed the form an ready. [SIC]

Standard #: 22VAC40-191-60-B
Description: Based on record review, the provider did not obtain a sworn statement or affirmation for a staff member before their first day of employment.

Evidence:
Staff#3's record did not contain a completed sworn statement or affirmation form.

Plan of Correction: Completed and signed the form.

Standard #: 22VAC40-191-60-C-2
Description: Based on record review, the provider did not obtain a central registry check for a staff member within 30 days of employment.

Evidence:
Staff#3's record does not contain a central registry check for each staff member within 30 days of employment. The staff member's first day of employment was documented as 6/12/2019.

Plan of Correction: Sent the form.

Standard #: 63.2-1720.1-A
Description: Based on record review, the provider did not update background check documentation for a household member every 5 years.

Evidence:
HH#2's record contains a central registry check that was last updated on 2/11/2014.

Plan of Correction: She has an appointment on August 27th at 3pm.

Standard #: 63.2-1720.1-B-2
Description: Based on record review, the provider did not obtain a fingerprint based background check for a staff member/household member prior to their first day of employment/residence.

Evidence:
Staff#3's record (DOH:06/12/2019) does not contain a fingerprint based background check result required prior to their first day of employment. HH#2 and HH#3's records do not contain fingerprint based background check results required for each person residing in the home.

Plan of Correction: House member#2 and #3 have appointments on August 21st at 10:40 am and 11:30 am.

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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