VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Khalida Naz
7706 Tower Woods Drive
Springfield, VA 22153
(703) 629-6913

Current Inspector: Leah Pagala (703) 537-6757

Inspection Date: Jan. 7, 2020

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 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 Licensure and Registration Procedures

Technical Assistance:

Technical assistance was offered regarding the following: Background checks - Provider was counseled on following up with the inspector regarding the missing background checks, health forms for children.

Comments:

An unannounced renewal inspection was conducted from 10:15 am through 12:30 pm. There were 4 children (10 points) with 1 caregivers present.4 children's records, 6 household member's records and 1 caregiver record was reviewed. The children were observed playing with educational and home living toys, writing their names and gettign ready for lunch. Emergency drill record and supplies were reviewed. A walk through of the family day home was conducted. There were no medications on site. Areas of non-compliance are identified in the violation notice. Please contact me if you have any questions at mahrukh.aziz@dss.virginia.gov or 571-835-4718.

Violations:

Standard #:	22VAC40-111-830-B
Description:	Based on record review, the family day home did not practice shelter in place drills twice a year. Evidence: The most recent shelter in place drill was conducted on 1/3/19. A second drill was not practiced.
Plan of Correction:	I will make sure that I conduct two shelter in place drills each year and document.
Standard #:	22VAC40-111-60-B
Description:	Based on records review, children's records did not contain complete information. Evidence: 1. Child # 1 and Child # 2's record was missing the liability insurance form. 2. Child # 2's record was missing both parent's work information, including the work address and phone numbers.
Plan of Correction:	I will get all the missing information from the parents.
Standard #:	22VAC40-111-170-A
Description:	Based on record review, the family day home did not obtain a Tuberculosis (TB) screening for an adult household member upon reaching the age of 18. Evidence: Household Member # 1 reached the age of 18 in October 2019. A negative TB screening was not obtained for Household Member # 1.
Plan of Correction:	The TB screening will be obtained as soon as possible.
Standard #:	22VAC40-111-180-A
Description:	Based on record reviews, the family day home did not obtain current Tuberculosis (TB) screenings for each caregiver and adult household members, every two years. Evidence: 1. Caregiver # 1's most recent TB screening expired on 7/11/19. 2. Household Member # 2's and 4's TB screening expired on 7/11/19. 3. Household Member # 3's TB screening expired on 7/12/19.
Plan of Correction:	I will get current TB screenings done for everyone.
Standard #:	22VAC40-111-280
Description:	Based on observation, cleaning agents were stored in an area accessible to children. Evidence: Cleaning agents were found stored under the sink in an unlocked cabinet, making them accessible to children.
Plan of Correction:	The cabinet was locked during the inspection.
Standard #:	22VAC40-191-40-D-4-a
Description:	Based on staff interview, the provider did not obtain a sworn disclosure statement (SDS) for an adult household member. Evidence: The provider stated that she did not have household member # 1 complete a SDS when household member # 1 reached the age of 18.
Plan of Correction:	I will have her complete the form today.
Standard #:	63.2-1721.1-B-2
Description:	Based on staff interview, the family day home did not obtain fingerprint results for an adult household member. Evidence: 1. Household Member # 1 reached the age of 18 in October 2019. 2. The provider stated that she did not obtain fingerprint results for Household Member # 1.
Plan of Correction:	The appointment will be made for the fingerprints within 10 days and the licensing inspector will be notified.