Inspection · 2025-09-16
Date
2025-09-16
Complaint Related
No
Licensing Inspector
Pamela Sneed
(804) 629-2691
(804) 629-2691
SHSIA monitoring inspection of an approved subsidy vendor to determine compliance with current subsidy requirements regarding the health and safety of children and to promote quality standards for the children in their care.
No
Areas Reviewed
8VAC20-800 Administration
8VAC20-800 Personnel
8VAC20-800 Household Members
8VAC20-800 Physical Health of Caregivers and Household members
8VAC20-800 Caregiver Training
8VAC20-800 Physical Equipment and Environment
8VAC20-800 Care of Children
8VAC20-800 Preventing the Spread of Disease
8VAC20-800 Medication Administration
8VAC20-800 Emergencies
8VAC20-820 THE LICENSE
8VAC20-770 Background Checks
2.1 Background Checks Code, Carbon Monoxide
54.1 Provider must be MAT certified to administer prescription medication.
During the inspection, the inspector reviewed the areas listed above to include standards found out of compliance during the previous inspection.
Inspector Notes
An unannounced, on-site focused monitoring inspection was conducted on 9/16/25, as a part of the provisional licensure period. The Licensing Administrator was also on-site during the inspection. The on-site inspection began at 1:15pm and ended at 2:45pm. The inspector reviewed compliance in the areas listed above. There were 11 children present and 2 caregivers; the point total was 28. The inspector reviewed 5 children?s records and 5 caregiver/household members records while on-site. The inspection included document review, tour of the daycare areas of the home and interview.
Please complete the plan of correction (POC) and date to be corrected sections for each violation
cited on the violation notice. Specify how the violation will be or has been corrected. Submit your
POC within five (5) business days from today, which will be the close of business on 9/24/25. A POC submitted after this date will not appear on the public website.
Violations
16Standard 22.1-289.011-F
Repeat violation.
The license and any other documents required by the Superintendent shall be posted in a conspicuous place on the licensed premises.
The current provisional license was not posted in the home.
The most recently issued inspection violation notice was not posted in the home. The
acknowledgement form from the 6/6/25 inspection was posted and the violation notice from the 7/18/24 inspection.
The license and any other documents required by the Superintendent shall be posted in a conspicuous place on the licensed premises.
The current provisional license was not posted in the home.
The most recently issued inspection violation notice was not posted in the home. The
acknowledgement form from the 6/6/25 inspection was posted and the violation notice from the 7/18/24 inspection.
Plan of Correction: Will make a print out of liscense. Will request inspector to mail "colored" copy to post. Waiting for colores "mailed" copy
[sic]
[sic]
Standard 22.1-289.035-B-2
Repeat violation.
All caregivers must have completed a national fingerprint background check (CRC) prior to employment.
There was no documentation of a CRC on-file for Caregiver #3.
All caregivers must have completed a national fingerprint background check (CRC) prior to employment.
There was no documentation of a CRC on-file for Caregiver #3.
Plan of Correction: Will submit CRC for caregiver #3 online. By the end of the week. [sic]
Standard 22.1-289.035-B-3
Repeat violation.
All caregivers must have completed a central registry search (CRS) prior to employment.
There was no documentation of a CRS on-file for Caregiver #3.
All caregivers must have completed a central registry search (CRS) prior to employment.
There was no documentation of a CRS on-file for Caregiver #3.
Plan of Correction: Will submit CRS for caregiver #3 online. By the end of the week. [sic]
Standard 8VAC20-770-40-D-5
Repeat violation.
Persons living in the home that are 14 years of age and older must have a central registry search (CRS) within 30-days of moving into the home or turning 14.
Household member #3 did not have a completed CRS.
Persons living in the home that are 14 years of age and older must have a central registry search (CRS) within 30-days of moving into the home or turning 14.
Household member #3 did not have a completed CRS.
Plan of Correction: Account made and waiting on resuts for household member #3. Resuts pending, next few weeks. [sic]
Standard 8VAC20-800-100-A
Repeat violation and systemic deficiency.
The provider shall 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.
1. Child #14-There was no documentation of a physical exam. The child's began attending in July 2024.
2. Child #18-There was no documentation of a physical exam. The child began attending in June 2025.
3. The provider said that she had not corrected the 5 previously cited records for not having a physical exam on-file.
[Note: 2 of the previously cited 5 records were reviewed today.]
The provider shall 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.
1. Child #14-There was no documentation of a physical exam. The child's began attending in July 2024.
2. Child #18-There was no documentation of a physical exam. The child began attending in June 2025.
3. The provider said that she had not corrected the 5 previously cited records for not having a physical exam on-file.
[Note: 2 of the previously cited 5 records were reviewed today.]
Plan of Correction: 1. Child #14 is no longer attending program. Her last day was October 3rd 2024.
2. Child #18, I don't have physical copy but have it on file online since June 11th 2025.
3. Child #15 is the sibling to child #14 no longer attends program.
Chid #16 will talk to parents.
Child #17 I have online format of physical.
By the end of the week.
[sic]
2. Child #18, I don't have physical copy but have it on file online since June 11th 2025.
3. Child #15 is the sibling to child #14 no longer attends program.
Chid #16 will talk to parents.
Child #17 I have online format of physical.
By the end of the week.
[sic]
Standard 8VAC20-800-120-B
Repeat violation.
Assistants' and substitute providers' records shall contain a minimum of 2 reference checks
The record for Caregiver #3 included no documentation of reference checks.
Assistants' and substitute providers' records shall contain a minimum of 2 reference checks
The record for Caregiver #3 included no documentation of reference checks.
Plan of Correction: Located two written references for caregiver #3. Now on file.
Standard 8VAC20-800-180-A
Repeat violation and systemic deficiency.
The provider shall obtain for each caregiver and adult household member a TB test/screening and documentation of results every 2 years.
1. Caregiver #1-The previous TB test was dated as completed 7/24/23.
2. Caregiver #2-The previous TB test was dated as completed 2/9/22. While there was a receipt of payment for a TB test on 8/9/24, there was no documentation of test results.
3. Household member #2-The previous TB test was dated as completed 8/1/23.
The provider shall obtain for each caregiver and adult household member a TB test/screening and documentation of results every 2 years.
1. Caregiver #1-The previous TB test was dated as completed 7/24/23.
2. Caregiver #2-The previous TB test was dated as completed 2/9/22. While there was a receipt of payment for a TB test on 8/9/24, there was no documentation of test results.
3. Household member #2-The previous TB test was dated as completed 8/1/23.
Plan of Correction: 1. TB test appointment made for this week on Monday 9/22. Test completed 9/22. Will be ready (results) by the end of this week.
2. TB test was completed, resuts on file. Filed results 9/24
3. TB test appointment made for 10/03. Will acquire resuts by week of 10/6
[sic]
2. TB test was completed, resuts on file. Filed results 9/24
3. TB test appointment made for 10/03. Will acquire resuts by week of 10/6
[sic]
Standard 8VAC20-800-200-A
Repeat violation.
The provider shall orient the substitute provider and assistant by the end of their first week of
assuming job responsibilities.
There was no documentation of orientation training completed for Caregiver #3.
The provider shall orient the substitute provider and assistant by the end of their first week of
assuming job responsibilities.
There was no documentation of orientation training completed for Caregiver #3.
Plan of Correction: Will provide written orientation to All staff members before employment. By the end of this week. [sic]
Standard 8VAC20-800-210-A
Repeat violation.
In addition to satisfactory completion of First Aid/ CPR training, caregivers shall obtain a
minimum of 16 hours of annual training in areas relevant to their job responsibilities.
1. Caregiver #1-0 of 16 hours of annual training were documented as completed.
2. Caregiver #2-0 of 16 hours of annual training were documented as completed.
In addition to satisfactory completion of First Aid/ CPR training, caregivers shall obtain a
minimum of 16 hours of annual training in areas relevant to their job responsibilities.
1. Caregiver #1-0 of 16 hours of annual training were documented as completed.
2. Caregiver #2-0 of 16 hours of annual training were documented as completed.
Plan of Correction: 1. Will complete annual training gradually within the next few weeks.
2. Will complete annual training gradually within next few weeks.
By the next 30 days.
[sic]
2. Will complete annual training gradually within next few weeks.
By the next 30 days.
[sic]
Standard 8VAC20-800-220-A
Repeat violation.
To safely perform medication administration practices listed in 8VAC20-800-710 whenever he family day home has agreed to administer prescription or non-prescription medications, the administration shall be performed by a caregiver who satisfactorily completed a medication administration training (MAT) course developed by the Board of Nursing.
Child #12 has an emergency medication in the home though no caregiver has completed MAT.
To safely perform medication administration practices listed in 8VAC20-800-710 whenever he family day home has agreed to administer prescription or non-prescription medications, the administration shall be performed by a caregiver who satisfactorily completed a medication administration training (MAT) course developed by the Board of Nursing.
Child #12 has an emergency medication in the home though no caregiver has completed MAT.
Plan of Correction: Will schedule Mat training course for provider. Within the next 30 days. [sic]
Standard 8VAC20-800-60-B
Repeat violation and systemic deficiency.
A child's record shall contain required information and there was no documentation the following:
1. Child #14-The physician information was left blank.
2. Child #20-The medical insurance information was incomplete.
3. The provider said that she had not corrected the 7 previously cited records for not having required information on-file.
[Note: 1 of the previously cited 7 records were reviewed today, as well as, the record of a newly enrolled child.]
A child's record shall contain required information and there was no documentation the following:
1. Child #14-The physician information was left blank.
2. Child #20-The medical insurance information was incomplete.
3. The provider said that she had not corrected the 7 previously cited records for not having required information on-file.
[Note: 1 of the previously cited 7 records were reviewed today, as well as, the record of a newly enrolled child.]
Plan of Correction: Child #14 is no longer enrolled in the program.
2. Will ask parent to provide insurance info. By the end of the week. [sic]
2. Will ask parent to provide insurance info. By the end of the week. [sic]
Standard 8VAC20-800-770
Repeat violation and systemic deficiency.
A working portable battery-operated weather band radio, and extra batteries shall be kept in a
designated area and be available to caregivers at all times.
There was no working portable battery- operated weather band radio in the home.
A working portable battery-operated weather band radio, and extra batteries shall be kept in a
designated area and be available to caregivers at all times.
There was no working portable battery- operated weather band radio in the home.
Plan of Correction: Will order a working portable weather band radio.
Standard 8VAC20-800-80-B
Repeat violation and systemic deficiency.
Within 7 business days of the child's 1st day of attendance the provider shall verify the identity and age of a child.
1. Child #18-There was no documentation verifying the child's proof of identity. First day of attendance was June 2025.
2. The provider said that she had not corrected the 8 previously cited records for verifying the child's proof of identity.
[Note: 1 of the previously cited 8 records were reviewed today.]
Within 7 business days of the child's 1st day of attendance the provider shall verify the identity and age of a child.
1. Child #18-There was no documentation verifying the child's proof of identity. First day of attendance was June 2025.
2. The provider said that she had not corrected the 8 previously cited records for verifying the child's proof of identity.
[Note: 1 of the previously cited 8 records were reviewed today.]
Plan of Correction: Requested (2) proof of identity to parents. [sic]
Standard 8VAC20-800-830-B
Repeat violation.
Shelter-in-place procedures shall be practiced a minimum of twice per year.
There was no documentation of shelter-in- place drills practiced in the last year.
Shelter-in-place procedures shall be practiced a minimum of twice per year.
There was no documentation of shelter-in- place drills practiced in the last year.
Plan of Correction: Will perform shelter in place twice a year. Need new log record. [sic]
Standard 8VAC20-800-90-A
Repeat violation.
Before a child may attend the family day home, the provider shall obtain documentation of
immunizations.
1. Child #14-There was no documentation of immunizations signed by a physician.
2. Child #18-There was no documentation of immunizations.
3. The provider said that she had not corrected the 5 previously cited records for not having immunizations on-file.
[Note: 2 of the previously cited 5 records were reviewed today.]
Before a child may attend the family day home, the provider shall obtain documentation of
immunizations.
1. Child #14-There was no documentation of immunizations signed by a physician.
2. Child #18-There was no documentation of immunizations.
3. The provider said that she had not corrected the 5 previously cited records for not having immunizations on-file.
[Note: 2 of the previously cited 5 records were reviewed today.]
Plan of Correction: 1. Child #14 no longer attends program. N/A
2. Child #18 no physical copy on file but have pdf format. Will make copy Copy will be made by 9/29
3. Have asked & request files of immunization to parents. Will have copies by end of moth
[sic]
2. Child #18 no physical copy on file but have pdf format. Will make copy Copy will be made by 9/29
3. Have asked & request files of immunization to parents. Will have copies by end of moth
[sic]
Standard 8VAC20-800-900-B
Children shall not be allowed to eat or drink while lying down.
A child was observed lying in a crib with a sip cup.
A child was observed lying in a crib with a sip cup.
Plan of Correction: Not available online. Contact Inspector for more information.