VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Kristine Kim
3612 West Ox Road
Fairfax, VA 22033
(703) 508-4965

Current Inspector: Karen Dickens (571) 423-6978

Inspection Date: Aug. 18, 2021

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

Comments:

This inspection was conducted by licensing staff using an alternate remote protocol, including telephone contacts, documents review, interviews and a virtual tour of the program. A monitoring inspection was initiated and concluded on August 18, 2021. The provider was contacted by telephone and a virtual inspection was conducted. There were 11 children(22pts) present, ranging in ages from 18 months to 5 years old, with three staff supervising. The inspector reviewed compliance in the areas of administration, physical plant, staffing and supervision, programming, special care and emergencies and nutrition. A total of two child records and three staff records and three household members records were reviewed. Information gathered during the inspection determined non-compliance with applicable standards or law and violations were documented on the violation notice issued to the program. Thank you for your cooperation today. If there are any questions, please contact karen.dickens@doe.virginia.gov.

Violations:

Standard #:	22VAC40-111-120-B
Description:	Based on record review, required records were not kept for each staff person. Evidence: 1. Staff #3's record (Date of hire-06/2021) did not have documentation of two reference checks.
Plan of Correction:	The provider will conduct two reference checks for staff.
Standard #:	22VAC40-111-200-A
Description:	Based on record review and interview, the provider did not orient the assistant by the end of their first week of assuming job responsibilities. Evidence: 1. Staff #3's record(Date of Hire-06/2021) did not contain documentation of orientation. 2. Staff #1 confirmed that orientation was not completed.
Plan of Correction:	The employee will complete orientation.
Standard #:	22VAC40-191-40-D-4-a
Description:	Based on record review, a Central Registry Search was not conducted for two household members. Evidence: 1. Central Registry Searches must be conducted every five years. Household Member #1 and Household Member #2's records contained expired Central Registry Findings. Household Member #1 and Household Member #2's findings were both dated 06/30/2016.
Plan of Correction:	A Central Registry Search will be conducted and once the results come back, the provider will email the results to the licensing inspector.
Standard #:	22VAC40-191-60-B
Description:	Based on record review, the family day home did not obtain a complete Sworn Disclosure Statement(SDS) for an employee. Evidence: 1. Staff #3's record (Date of hire-06/2021) did not contain a completed Sworn Disclosure Statement.
Plan of Correction:	The employee will complete a Sworn Disclosure Statement Form.
Standard #:	22VAC40-191-60-C-2
Description:	Based on record review and interview, the family day home did not complete a Central Registry Search within 30 days of employment. Evidence: 1. Staff #3's record (Date of Hire-06/2021) did not contain documentation of a completed Central Registry Search. 2. Staff #1 confirmed that a Central Registry search was not conducted to date. 3. Staff #1's record contained an expired Central Registry Finding. The Central Registry Finding was dated 06/30/2016.
Plan of Correction:	A Central Registry Search will be conducted for the employees. Once results are returned, the provider will email the results to the licensing inspector.