VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Surisa Phumtim
6251 Marcy Court
Alexandria, VA 22310
(703) 971-9333

Current Inspector: Kelly Patterson-Savittiere (703) 479-4746

Inspection Date: Nov. 22, 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 Preventing the Spread of Disease 22VAC40-111 Medication Administration 22VAC40-111 Emergencies 22VAC40-111 Nutrition 22VAC40-111 Transportation 22VAC40-111 Nighttime Care 22VAC40-80 THE LICENSE. 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

Technical Assistance:

Licensing inspector discussed possible corrective action and consultation with provider

Comments:

An unannounced renewal inspection was conducted today from approximately 10am-12:20pm. There were 11 children (36 points) in the direct care and supervision of 3 caregivers. A sample of 6 children?s records and 3 caregiver's records and 1 household member's record were reviewed. The children were observed napping, washing hands, playing, eating, and engaged with caregivers. One new caregiver has been hired since the last inspection. Areas of non-compliance are identified in this report. The exit interview was conducted with the provider. If you have any questions, contact Kimberly.Sawyer@dss.virginia.gov.

Violations:

Standard #:	22VAC40-111-120-B
Description:	Based on record review, the assistant's record did not contain required information. Evidence: The record of Assistant A was missing the following required information: 1. Verification of age; 2. Job title 3. Date of Employment 4. Name, address and phone number of an emergency contact; 5. Two references.
Plan of Correction:	I will complete this within two weeks.
Standard #:	22VAC40-111-60-B
Description:	Based on record review, each child's record did not contain required information. Evidence: 3 of 6 children's records reviewed were missing required information. 1. Children C and D were missing the medical insurance policy number. 2. Child E was missing the father's work phone number.
Plan of Correction:	I will be able to fix next week.
Standard #:	22VAC40-111-80-A
Description:	Based on record review and interview, the provider did not obtain proof of identity for the children in care within seven business days of attendance. Evidence: 1. The Caregiver B stated the parent documents the birth certificate portion of the files. 2. The children in care began attendance over seven business days ago and none of their proof of identity was obtained by Caregiver B.
Plan of Correction:	I will try to few next week but because of the holiday I can do it in two weeks.
Standard #:	22VAC40-111-170-A
Description:	Based on record review, the provider did not obtain a current report of tuberculosis screening for each Caregiver. Evidence: Assistant A did not have a tuberculosis screening on file.
Plan of Correction:	I will get it within two weeks.
Standard #:	22VAC40-111-280
Description:	Based on observation, potentially poisonous materials were not inaccessible to children. Evidence: There was hand sanitizer, and airfreshener located on top of the toilet in the bathroom being used by children.
Plan of Correction:	Corrected during inspection.
Standard #:	22VAC40-111-320-B
Description:	Based on observation, unused electrical outlets were not covered with protective covers. Evidence: An electrical outlet located upstairs in the room with approximately 8 cribs was not covered.
Plan of Correction:	I will fix it today.
Standard #:	63.2-1720.1-B-2
Description:	Based on record review and interview, each caregiver did not have complete fingerprinting results. Evidence: Assistant A did not have complete fingerprinting results before the first day of attendance. Caregiver
Plan of Correction:	I will make an appointment for her.