VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Uzma Khan
3102 Furman Lane
Apt. #203
Alexandria, VA 22306
(571) 289-5979

Current Inspector: Sarah Marbert (703) 479-4678

Inspection Date: Jan. 9, 2020

Complaint Related: No

Areas Reviewed:

22VAC40-111 Administration 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

Comments:

An announced Initial inspection was conducted today. There is one child present (4 points) with one caregiver. 1 adult and one child's records were reviewed. The child was observed playing, drinking water and watching a musical video. See violation notice for additional non-compliances. I cannot submit your application for approval until i have viewed the Central registry search results. Please contact me as soon as you receive those results. LI was present today from 9:30 AM - 11:45 AM. If you have any questions, please contact me at 703-479-4678 or at Sarah.Marbert@dss.virginia.gov.

Violations:

Standard #:	22VAC40-111-770
Description:	Based on direct observation, there is no working flashlight or weather band radio available. Evidence: The radio is not a weather band radio - only AM/FM. The flashlight does not work.
Plan of Correction:	I will get a new flashlight and radio.
Standard #:	22VAC40-111-920
Description:	Based on direct observation, the menu posted is not accurately date. Evidence: The menu available for review is dated 2/2018
Plan of Correction:	I will correct the dates on the menu and post the form
Standard #:	22VAC40-111-60-A
Description:	Based on a review of records, one child's record is incomplete. Evidence: Child #1's record is missing: Parents work address, Emergency contact address, Doctor's address, insurance information (medical insurance and policy number).
Plan of Correction:	I will use the model forms provided to include all information. I will ask the parent to complete the forms.
Standard #:	22VAC40-111-70-A
Description:	Based on a review of records, one child' record does not include written acknowledgement of all required policies and procedures. Evidence: Missing information includes, check in/out procedures, DSS website address, Provisions of the emergency preparedness plan, liability insurance declaration.
Plan of Correction:	I will use the model forms that includes all information. I will have the parent sign the new forms.
Standard #:	22VAC40-111-690-D
Description:	Based on direct observation, the diapering surface is not nonabsorbent. Evidence: There are hole sin the diapering pad surface, making it absorbent when cleaned or used.
Plan of Correction:	I will get a new diapering pad.
Standard #:	22VAC40-191-40-C-1-a
Description:	Based on a review of records, one caregiver record is incomplete. Evidence: The record for Caregiver A is missing a completed Central registry search (CPS).
Plan of Correction:	I will search or the form, or submit a new form