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

Current Inspector: Charles Perkins (703) 309-3963

Inspection Date: Feb. 23, 2017

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
22VAC40-111 Care of Children
22VAC40-111 Preventing the Spread of Disease
22VAC40-111 Medication Administration
22VAC40-111 Emergencies
22VAC40-111 Nutrition
22VAC40-80 THE LICENSE.
22VAC40-80 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
54.1-3408 Provider must be MAT certified to administer prescription medication.

Technical Assistance:
Discussion was held on the topics of current enrollment and current staffing. The following forms were given to the Family Day Home Provider: Assistant/Substitute Provider Record, and the Documentation of Assistant and Substitute Provider Orientation Training form.

Comments:
The following inspection took place between the hours of 9:50 am through 12:30 pm. Today, I met with the Provider on site at her Family Day Home (FDH) located in Centreville, Virginia. At the start of this unannounced monitoring inspection there were a total of 8 children (see violation notice). The number of children soon dropped to 6 children (17 points) with 2 caregivers. A total of 6 children?s files and 6 staff/household member?s files were reviewed. The children were engaged in the following: freeplay, games, music, movie time, toy play, 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 #: 22VAC40-111-100-A
Description: Based on review, 5 of 6 children's files 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 (02/23/2017), the following children were without a physical on file: Child #1 (start date - 01/01/2016), Child #2 (start date - 01/01/2016), Child #3 (start date - 08/19/2016), Child #5 (start date - 01/03/2017), and Child #6 (start date - 01/03/2017). 2. This review was confirmed by the Provider on the date of inspection.

Plan of Correction: The Parents of all applicable children shall be contacted and a current physical shall be obtained.

Standard #: 22VAC40-111-40-A
Description: Based on observation and interview, the Provider did not ensure that the total number of children receiving care at any one time did not exceed the maximum licensed capacity of the home. Evidence - 1. On the date of inspection (02/23/2017 at approximately 9:50 am) there were a total of 8 children within the Family Day Home (FDH) being provided care with 2 caregivers. It was unclear prior to that time, on how long the FDH was providing care for all 8 children. 2. The capacity stated on the current FDH license is 7. This license was posted. 3. The Provider stated (during an interview conducted on the date of inspection) that two of the children were being watched just for today and were not enrolled. 4. The two children who were not enrolled in care left at 9:56 am.

Plan of Correction: Correct on the date of inspection. The Parent of the children who were not enrolled, but were being provided care were picked up at 9:56 am bringing the FDH within their current capacity.

Standard #: 22VAC40-111-50-A
Description: Based on observation, the Family Day Home (FDH) did not keep a written record of the children in attendance for the date of inspection. Evidence - 1. On the date of inspection (02/23/2017), there was no record of attendance for the 8 children in care. 2. The Provider confirmed this observation on the date of inspection.

Plan of Correction: Corrected on the date of inspection.

Standard #: 22VAC40-111-60-B
Description: Based on review, 6 of 6 children's files reviewed indicated that those files reviewed did not contain all of the required information/documentation. Evidence - 1. On the date of inspection (02/23/2017), 2 complete emergency contact information was not available for: Child #1 (missing 1 phone number), Child #2 (missing 1 phone number), Child #5 (missing 2 phone numbers), Child #6 (missing 2 phone numbers). 2. The following children were missing the policy number for their medical insurance: Child #3, Child #4, Child #5, and Child #6. 3. The Information for Parents form was not signed by the Parents of the following children: Child #3, and Child #5. The Information for Parents form was not complete for Child #6.

Plan of Correction: All missing information and/or documentation shall be completed and/or signed.

Standard #: 22VAC40-111-70-A
Description: Based on review, 6 of 6 children's files reviewed indicated that it could not be verified in writing that all of the parents were provided all required information. Evidence - 1. On the date of inspection (02/23/2017), the Policy for the Administration of Medications form was not signed by the Parents of the following children: Child #1, Child #2, Child #3, Child #4, Child #5, and Child #6. 2. This observation was confirmed on the date of inspection by the Provider.

Plan of Correction: Parents shall by contacted in order to sign this documentation.

Standard #: 22VAC40-111-520-B
Description: Based on observation, a crib was used as a play space for an infant in care. Evidence - 1. On the date of inspection (02/23/2017), Child #3 was observed playing in a crib with toys and blocks. 2. Later, at nap time, those items were removed.

Plan of Correction: The child shall be moved to a play area.

Standard #: 63.2-1701-F
Description: Based on observation, documents required by the Commissioner were not posted in a conspicuous place on the licensed premises. Evidence - 1. On the date of inspection (02/23/2017) the violation notice issued for an inspection conducted on 12/07/2016 was not posted. 2. The Provider kept these reports within a file kept on site at the FDH.

Plan of Correction: The current issued reports from today shall be posted.

Standard #: 63.2-1809.1-B
Description: Based on review, 6 of 6 children's files reviewed indicated that there was no written acknowledgement that the Parents of the children in care received a notice of liability statement from the Provider for the Family Day Home (FDH). Evidence - 1. On the date of inspection (02/23/2017), the signature section on the notice of liability form was left blank for all 6 children currently enrolled at the FDH. 2. This observation was confirmed on the date of inspection by the Provider.

Plan of Correction: All Parents shall be contacted and this form shall be reviewed and signed in order to serve as a written acknowledgement for the status of the FDH's liability coverage.

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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