VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Helai Sherzuye
19907 Ridgecrest Square
Ashburn, VA 20147
(571) 279-2167

Current Inspector: Karen Dickens (571) 423-6978

Inspection Date:

Complaint Related: No

Violations:

Standard #:	8VAC20-800-100-A
Description:	Based on record review and interview, the provider did not obtain documentation of a physical examination by or under the direction of a physician prior to a child's attendance or within 30 days after the first day of attendance. Evidence: 1. Child #3's record (Start date-1/26/22) did not contain documentation of a physical examination. 2. Child #4's record (Start date-11/29/21) did not contain documentation of a physical examination . 3. Caregiver #1 confirmed a physical examination was not obtained from the parents.
Plan of Correction:	The provider will get a copy of the physical examinations from the parents and document the record.
Standard #:	8VAC20-800-60-B
Description:	Based on record review, children's records did not contain required information. Evidence: 1. Child #1's record (Start date-8/24/22) did not contain documentation of authorization to go off premises. 2. Child #2's record (Start date-2/28/22) did not contain documentation of name, address, and phone number of two emergency contacts, medical insurance and policy number, authorization of emergency care, and authorization to go off premises. 3. Child #3's record (Start date-1/26/22) did not contain documentation of medical insurance and policy number and authorization of emergency care. 4. Child #4's record (Start date-11/29/21) did not contain documentation of authorization to go off premises.
Plan of Correction:	The provider will get the missing information from the parents and document the record.
Standard #:	8VAC20-800-70-A
Description:	Based on record review, parents were not provided in writing before the first day of attendance whether or not there is liability insurance of at least $100,000 per occurrence and $300,000 aggregate in force on the family ay home. Evidence: 1. Child #2 and Child #4's record did not contain documentation of a Liability Insurance Declaration.
Plan of Correction:	The provider will get the parents to sign the Liability Insurance Declaration.
Standard #:	8VAC20-800-210-A
Description:	Based on record review and interview, the provider did not complete a minimum of sixteen clock hours of training annually in areas relevant to their job responsibilities. Evidence: 1. Caregiver #1 did not complete a minimum of 16 clock hours of annual training. Caregiver #1 confirmed that the annual training was not completed.
Plan of Correction:	The provider will complete 16hours of annual training.
Standard #:	8VAC20-800-320-B
Description:	Based on observation, child resistant protective covers larger than 1-1/4 inches in diameter were not installed on all unused electrical outlets accessible to children under five years of age. Evidence: 1. Three electrical outlets accessible to four children under the age of five years old were not covered with protective covers.
Plan of Correction:	Protective covers will be placed on the electrical outlets.
Standard #:	8VAC20-800-540-A
Description:	Based on observation, high chairs were not used according to the manufacturer's instructions and when occupied by a child, a safety was not used and securely fastened. Evidence: 1.Chil d#4 (16 months old) was seated in a high chair without a safety strap securely fastened.
Plan of Correction:	The provider will ensure that when children are placed into the high chairs, the security strap will be fastened.