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Rukhsana Dawlatzai
42971 Golfview Drive
Chantilly, VA 20152
(602) 733-7957

Current Inspector: Ariel Hayes (804) 629-7124

Inspection Date: Jan. 18, 2018

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 Emergencies
22VAC40-111 Nutrition
63.2 Liability Insurance Disclosure
22VAC40-191 Background Checks for Child Welfare Agencies

Technical Assistance:
The climbing structure shall be removed from the backyard brick patio area before children enter the backyard play area. The provider shall submit documentation of completed training hours for herself and assistant caregiver A prior to the renewal of the license.

An unannounced full renewal inspection was conducted today. The provider and two assistant caregivers were caring for 12 children, totaling 32 points. Children's records, caregiver and adult household records, training records, children's nutrition, emergency preparedness items, and the physical plant were inspected today. It was reported to the Inspector that there were no children's medications on site today. The children were observed dancing to music, playing with toys, and eating lunch. The children were served rice with chicken and mixed vegetables, apple slices, and milk for lunch today. This inspection was completed between approximately 9:45am and 11:45 am. Thank you for meeting with me today. If you have any questions regarding this inspection please email me at

Standard #: 22VAC40-111-800-B
Description: Based on a review of emergency preparedness items, it was determined that the provider has not conducted an annual review of the emergency preparedness plan. Evidence: The provider most recently documented a review of the emergency preparedness plan on 1/12/17.

Plan of Correction: I will review the plan this week.

Standard #: 22VAC40-111-920
Description: Based on a review of posted documents, it was determined that one required document was not posted. Evidence: The provider serves meals and snacks, but no menu has been posted for this week.

Plan of Correction: I will remember to post the menu at the start of each week.

Standard #: 22VAC40-111-100-A
Description: Based on a review of children's health records, it was determined that two records do not include a physical exam report. Evidence: There is no physical exam report on file for child #4 and #5.

Plan of Correction: I will remind each parent to return the completed physical form.

Standard #: 22VAC40-111-60-B
Description: Based on a review of children's records, it was determined that four records were not complete. Evidence: 1. Child records #2, #3, and #4 do not include documentation showing that each parent has reviewed their child's contact information within the past year. 2. Child record #5 does not include the address for one emergency contact person.

Plan of Correction: All parents will be asked for the missing information.

Standard #: 22VAC40-111-70-A
Description: Based on a review of administrative documents, it was determined that one parent has not signed one required document. Evidence: There is no signed "Declaration of Liability Insurance" document in the file for child #5.

Plan of Correction: I will ask the parent to sign the form today.


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. To find programs participating in Virginia Quality, click here.

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