Mandana Nassiri

8VAC20-800-120-B · Providers must maintain a record for each caregiver which contains all required information. The record for Caregiver #3 did not contain documentation that two or more references as to character and reputation as well as competency were checked before employment. Caregiver #3 has been working for one week.

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8VAC20-800-170-B · Providers must obtain a current tuberculosis screening from a caregiver at the time of hire and prior to coming into contact with children. The form shall have been completed within the last 30 days and be signed by a physician, physicians' designee, or an official of the local health department.

The tuberculosis screening for Caregiver 2, who has been caring for children for 6 months, was obtained more than 10 months prior to Caregiver's date of hire.

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8VAC20-800-780-B · Annually, the provider shall review with the parent the emergency contact information required in 8V AC20-800-60 B 2 to ensure the information is correct, and obtain the parent's signed acknowledgment of the review

The provider has not reviewed with the parent the emergency contact information in the child's record for 15 months.

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22.1-289.035-B-2 · Based on review, 2 of 3 staff files indicated that fingerprint checks (FPC) were not obtained prior to the first day of employment.

Evidence - 1. On the date of inspection (12/05/2023) FPCs were not available for review for: Staff #2 (start date - 11/22/2023), and Staff #3 (start date - 11/29/2023). 2. Both staff were providing care on site on the date of inspection.

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8VAC20-770-40-D-1-a · Based on review, 2 of 2 staff files, and 2 of 4 household records indicate that some documentation on site has expired (older than 5 years).

Evidence - 1. On the date of inspection (05/24/2023), the following searches of the central registry ( CPS ) checks were expired: Staff #1 ( CPS check dated - 04/07/2018), and Staff #2 ( CPS check dated - 04/07/2018). Household Member #1 ( CPS check dated - 04/07/2018), and Household Member #2 ( CPS check dated - 04/07/2018). 2. On the date of inspection, the following sworn statements (SDS) were expired: Staff #1 (SDS check dated - 03/18/2018), and Staff #2 (SDS check dated - 03/18/2018). Household Member #1 (SDS check dated - 03/18/2018), and Household Member #2 (SDS check dated - 03/18/2018).

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8VAC20-800-60-B · Based on review, 1 of 6 children files indicated that not all of the required information was contained within each child's record.

Evidence - 1. On the date of inspection (05/24/2023), the policy number for the listed medical insurance for Child #4 was not available. 2. The start date for Child #4 was listed as 03/20/23.

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8VAC20-800-90-C · Based on review, 1 of 6 children files indicated that the Family Day Home (FDH) did not obtain documentation of additional immunizations for a child (who was not exempt from the immunization requirements according to subsection B of this section) once every six months for children under the age of two years.

Evidence - 1. On the date of inspection (05/25/2023), the current immunization page on file for Child #2 was dated - 10/10/2022. 2. Based on the information on file, Child #2 was under 2 years of age on the date of inspection.

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8VAC20-800-180-A · Based on review, 2 of 5 household records indicated that the Provider did not obtain for each adult household member a current Report of Tuberculosis Screening (TB) form (in accordance with the requirements in 8VAC20-800-170), every two years.

Evidence - 1. On the date of inspection (11/15/2022), the following household members had TB documentation on file that was older than 2 years: Household Member #1, and Household Member #3. 2. The dates listed for the TB documentation on file were as follows: For Household Member #1 (TB documentation was dated - 09/18/2020), and For Household Member #3 (TB documentation was dated - 09/14/2020).

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8VAC20-800-90-C · Based on review, 1 of 7 children files indicated that the Family Day Home (FDH) did not obtain documentation of additional immunizations for a child (who was not exempt from the immunization requirements according to subsection B of this section) once every six months for a child under the age of two years.

Evidence - 1. On the date of inspection (04/27/2022), an immunization record for Child #3 was dated - 08/10/2021. 2. Based on the information contained on file, on the date of inspection, Child #3 was under two years of age.

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22VAC40-111-830-B · Based on review and interview, a shelter-in-place drill was not practiced a minimum of twice a year.

Evidence - 1. Based on the information recorded on the Family Day Home emergency response drill log, a shelter-in-place drill has not been recorded during the current year of 2021. 2. The Provider stated (during an interview conducted on the date of inspection 11/04/2021) that while a fire drill has been conducted for each month, a shelter-in-place drill has yet to be conducted in 2021.

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