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

Current Inspector: Charles Perkins (703) 309-3963

Inspection Date: Nov. 29, 2018

Complaint Related: Yes

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
22VAC40-191 Background Checks for Child Welfare Agencies
54.1-3408 Provider must be MAT certified to administer prescription medication.

Technical Assistance:
Discussion and review of issues of an alleged non-compliance that presented itself to the Division of Licensing in a reported complaint. All areas of the standard were reviewed in order to fulfill the requirement of counting this as a mandated inspection.

The following unannounced complaint inspection took place on 11/29/2018, between the hours of 10:30 am through 1 pm, on site at the family day home located in Centreville, Virginia. Based on all available evidence, the following are the findings for those areas of the standard that were in review: 22VAC40-111-(2)-90-C Not Reported / Found 22VAC40-111-(5)-180-A Not Reported / Found 22VAC40-191(BC)-40-D-4-a Reported / Valid 22VAC40-111-(7)-240-A Reported / Not-Valid 22VAC40-111-(11)-800-B Not Reported / Found If you should have any future questions with regards to these findings, please call. Thank you. Charlie Perkins, Licensing Inspector (703) 309-3963

Standard #: 22VAC40-111-800-B
Complaint related: No
Description: Based on observation, the Provider did not document the required annual review of the Family Day Home's (FDH's) Emergency Preparedness and Response Plan (EP&RP). Evidence - 1. On the date of inspection (11/29/2018), the most recent documented review of the posted EP&RP was dated - 01/04/2017. 2. The Provider reviewed and documented the EP&RP, with no additional updates, on the date of inspection.

Plan of Correction: Reviewed on the date of inspection and documented.

Standard #: 22VAC40-111-90-C
Complaint related: No
Description: Based on review, 1 of 3 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 (11/29/2018), Child #1's most recent immunization page documentation was dated - 04/05/2018. 2. On the date of inspection, based on information on file, Child #1 was under the age of two years.

Plan of Correction: An updated immunization page shall be obtained and placed on file for Child #1.

Standard #: 22VAC40-111-180-A
Complaint related: No
Description: Based on review, 2 of 4 household member's files reviewed indicated that the Provider did not obtain for each adult household member a current Report of Tuberculosis Screening (TB) form (in accordance with the requirements in 22 VAC 40-111-170), every two years from the date of the most recent TB documentation on file. Evidence - 1. On the date of inspection (11/29/2018), the following household member's had TB documentation on file at the FDH that was older than 2 years: Household Member #1, and Household Member #2. 2. The TB documentation on file for Household Member #1 was dated - 09/09/2016. The TB documentation on file for Household Member #2 was dated - 07/15/2016.

Plan of Correction: TB documentation for both household members shall be updated and placed on file.

Standard #: 22VAC40-191-40-D-4-a
Complaint related: Yes
Description: Based on observation and interview, a new household member did not have on file a sworn statement or affirmation (SDS) when a person age 18 years or older begins residing in the home; and a search of central registry (CPS) and a criminal history record check (CRC) within 30 days of a person 18 years of age or older begins to residing in the home. Evidence - 1. The Provider stated (during an interview conducted on the date of inspection - 11/29/2018) that other than her three children and mother that their were no other adults (persons over 18 years of age) living in the home. 2. At approximately 12:30 pm. , an unidentified person was observed coming down the stairs and then exiting the home. When asked by the LI who that person was, the Provider responded that she was a renter (Household Member #5). 3. The Provider then stated the Household Member #5 moved in to her home on October 3, 2018. 4. There is currently no file on Household Member #5, to include: a CPS check, a CRC check (fingerprint check), and a SDS.

Plan of Correction: Household Member #5 will be asked to leave by December 8, 2018. If she does stay, all required documentation shall be on file and sent within ten days.


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.