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Jayanthi Samarasekara
14725 Calvary Place
Centreville, VA 20121
(571) 565-1686

Current Inspector: Charles Perkins (703) 309-3963

Inspection Date: Dec. 7, 2016

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
22VAC40-111 Transportation
22VAC40-80 THE LICENSE.
22VAC40-80 THE LICENSING PROCESS.
63.2 General Provisions.
63.2 Child Abuse and Neglect
63.2 Licensure and Registration Procedures
63.2 Facilities and Programs..
63.2 Liability Insurance Disclosure
22VAC40-191 Background Checks for Child Welfare Agencies

Technical Assistance:
Discussion was held on the topics of current enrollment, current staffing, and that the mesh crib located on site is never to be used for a place for a child to sleep. The Provider was given copies of many of the Family Day Home model forms to include: Liability insurance declaration, Provisions of the Emergency Preparedness & Response Plan, the Emergency Preparedness & Response Plan, Information for parents form, Policy for the Administration of Medications form, Authorization to apply a non-prescription topical skin product, record of annual training, record of daily attendance, record of emergency response drills, menu, and Child's Record.

Comments:
The following inspection took place between the hours of 10 am through 1:30 pm. Today, I met with the Provider on site at her Family Day Home (FDH) located in Centreville, Virginia. At the start of this announced initial inspection there were a total of 4 children (13 points) with 1 caregiver. A total of 4 children?s files and 6 staff/household member?s files were reviewed. The children were engaged in the following: infant sleeping, music, toy play, freeplay, diaper changing, hand washing, lunch, nap time, and other organized activities. If you should have any future questions, please call. Thank you. Charlie Perkins, Licensing Inspector (703) 309-3963

Violations:
Standard #: 22VAC40-111-760-A
Description: Based on review, not all of the required supplies were contain within the Family Day Home's (FDH) first aid kit. Evidence - 1. On the date of inspection (12/07/2016), the first aid kit only contained 1 of 2 triangular bandages. 2. This was confirmed on the date of inspection by the Provider.

Plan of Correction: An additional one shall be purchased.

Standard #: 22VAC40-111-770
Description: Based on review and interview, the Family Day Home (FDH) did not have a working portable battery-operated weather band radio. Evidence - 1. On the date of inspection (12/07/2016) a weather band radio was not available for review. 2. The Provider stated (during an interview conducted on the date of inspection), that a crank operated weather band radio was purchase earlier, but was returned.

Plan of Correction: A new weather band radio (battery-operated) shall be purchased.

Standard #: 22VAC40-111-100-A
Description: Based on review, 3 of 4 children's file reviewed indicated that the Provider did not obtain documentation of a physical examination by or under the direction of a physician prior to a child's attendance or within 30 days after the first day of attendance. Evidence - 1. On the date of inspection (12/07/2016), documentation of a physical examination was not available for: Child #1, Child #2, and Child #3. 2. The following are their start dates: 01/01/2016 (Child #1, and Child #2), and 08/19/2016 (Child #3).

Plan of Correction: Documentation of a physical shall be obtained for all applicable children.

Standard #: 22VAC40-111-50-A
Description: Based on review, the Family Day Home did not keep a written record of children in attendance each day. Evidence - 1. On the date of inspection (12/07/2016), a daily attendance was not being recorded. 2. At the time of inspection, there were a total of four children in care.

Plan of Correction: A record of attendance will now be kept for each day.

Standard #: 22VAC40-111-60-B
Description: Based on review, 4 of 4 children's files reviewed indicated that not all of the required information/documentation was contained within each child's record. Evidence - 1. On the date of inspection (12/07/2016), the parent's work address and telephone number was not available for the following children: Child #1, Child #2, Child #3, and Child #4. 2. On the date of inspection, the addresses for the 2 emergency contacts listed for Child #1, Child #2, Child #3, and Child #4 were not available for review. 3. On the date of inspection, the policy number for the following children's medical insurance was not available: Child #1, and Child #2. Both the policy name and number were not available for Child #4. 4. On the date of inspection, the Proof of Identification for Child #1, Child #2, Child #3, and Child #4 were not available for review. The following are their start dates: 01/01/2016 (Child #1, and Child #2), 08/19/2016 (Child #3), and 09/26/2016 (Child #4).

Plan of Correction: All missing information/documentation shall be obtain and placed in the applicable child's record.

Standard #: 22VAC40-111-70-A
Description: Based on review, the information for parents form that is provided to the parents was not complete. Evidence - 1. On the date of inspection (12/07/2016), sections of the Code of Virginia were not included in the Information for Parents form created by the Family Day Home (FDH), such as: 63.2-1509, 63.2-1813 and notice of standard #650. This was applicable for: Child #1, Child #2, Child #3, and Child #4. 2. The Policy for the Administration of Medication form was not completed for: Child #1, Child #2, Child #3, and Child #4. 3. The Provisions Of The Emergency Preparedness And Response Plan form was not completed for: Child #4.

Plan of Correction: All new documentation will be completed for all applicable children and placed on file.

Standard #: 22VAC40-111-90-C
Description: Based on review, 1 of 4 children's files reviewed indicated that the Family Day Home (FDH) did not obtain documentation of additional immunizations for a child (who was not exempt from the immunization requirements according to subsection B of this section) once every six months for children under the age of two years. Evidence - 1. On the date of inspection (12/07/2016), the most current immunization page available for Child #2 was dated - 06/30/2015. 2. On the date of inspection, based on the information on file, Child #2 was under the age of two years.

Plan of Correction: An updated immunization page shall be obtained and placed on file.

Standard #: 22VAC40-111-240-A
Description: Based on observation, an area outside was not maintained in a safe condition. Evidence - 1. On the date of inspection (12/07/2016), outside in the backyard, two areas were observed with old wood. 2. Those two areas include: a wooden patio that had a picnic table on top. The wood is old, heavily weathered, and is deteriorating. The second area is the wood deck attached to the house that appears to be in similar shape.

Plan of Correction: These areas shall be addressed in the spring; they shall be removed.

Standard #: 22VAC40-111-330-A
Description: Based on observation, a landline telephone was not available. Evidence - 1. On the date of inspection (12/07/2016), a landline telephone was not available for review. 2. This was confirmed on the date of inspection by the Provider.

Plan of Correction: A landline telephone shall be purchased.

Standard #: 63.2-1809.1-A
Description: Based on review, 4 of 4 children's file reviewed indicated that a signed acknowledgement of a furnished written of liability notice from the Provider for the Family Day Home was not available. Evidence - 1. On the date of inspection (12/07/2016), a Liability Insurance Declaration form signed by the child's parent was not available for review. 2. This was observed to apply to: Child #1, Child #2, Child #3, and Child #4.

Plan of Correction: This form shall be completed for all applicable children and placed on file.

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.

Virginia Quality is a voluntary quality rating and improvement system for early care and education facilities serving children ages birth through pre-K. Eligible child care facilities must be fully licensed, licensed exempt and a VDSS subsidy vendor, or a voluntary registered day home and a VDSS subsidy vendor. Only programs enrolled in Virginia Quality will display a rating. Virginia Quality contact information for your region is available at the following link Regional Contacts.

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