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Olivia Roane Jackson
701 Maggie Walker Avenue
Richmond, VA 23222
(804) 614-5997

VDSS Contact: Jaime Harris (804) 807-3278

Inspection Date: May 16, 2023

Complaint Related: No

Areas Reviewed:
8VAC20-850 PROVIDER REGISTRATION AND GENERAL PROCEDURES
8VAC20-850 HEALTH AND SAFETY CHECKLIST
20 Access to minor?s records
22.1 Background Checks Code; storage of firearms
63.2 Child abuse and neglect
8VAC20-770 Background Checks

Comments:
An unannounced renewal inspection was conducted on Tuesday, May 16, 2023, from approximately 1:45pm to 2:55pm, to review compliance with the Voluntary Registration Requirements. This inspection was conducted in conjunction with a Subsidy inspection. There
were four children in care during the inspection. A walk-through of the home was conducted with the provider. Administrative records, emergency supplies and equipment and areas of the home where children are present were inspected. One caregiver/ household member record and four children?s records were reviewed during this inspection. The provider stated that transportation is not provided at this time and medication is not administered. Information gathered during the inspection determined areas of non-compliance with applicable regulations or law, and violations were documented on the violation notice issued to the provider.
If you have any questions regarding the inspection, please contact the licensing inspector at (804) 929-3771.

Violations:
Standard #: 8VAC20-850-90-B
Description: Based on documentation review, the provider did not maintain a signed statement from each parent, affirming receipt of the information to parents statement.
Evidence:
1. The record of child #1 (estimated enrollment date: 7/2021) did not have documentation showing receipt of the information to parents statement.
2. The record of child #2 (estimated enrollment date: 7/2021) did not have documentation showing receipt of the information to parents statement.
3. The record of child #3 (enrollment date: unknown) did not have documentation showing receipt of the information to parents statement.
4. The record of child #4 (enrollment date: 6/4/2021) did not have documentation showing receipt of the information to parents statement.

Plan of Correction: Not available online. Contact Inspector for more information.

Standard #: 8VAC20-850-90-C
Description: Based on record review, the provider did not ensure that children?s records contained all of
the required information.
Evidence:
1. The record of child #1 (estimated enrollment date: 7/2021) did not contain the following required information: Child?s Name, First Day of Attendance, Address, Gender, proof of identity,the name of the parent's hospitalization plan and number or medical assistance plan, if applicable; the parent's signed authorization for the child's emergency medical treatment; Disclosure to administer/not administer medication; Permission for field trips; names of persons authorized to visit or call for the child, as well as those who are not to visit or call for the child; any written agreement made between the family day provider and the natural parent, guardian, or other responsible person for each child in care. The agreement may cover hours of care per day, week, or month; cost of care per day, week, or month; frequency and amount of payment per day, week, or month; and any special services to be .
2. The record of child #2 (estimated enrollment date: 7/2021) did not contain the following required information: Child?s Name, First Day of Attendance, Address, Gender, proof of identity, the name of the parent's hospitalization plan and number or medical assistance plan, if applicable; the parent's signed authorization for the child's emergency medical treatment; Disclosure to administer/not administer medication; Permission for field trips; names of persons authorized to visit or call for the child, as well as those who are not to visit or call for the child; any written agreement made between the family day provider and the natural parent, guardian, or other responsible person for each child in care. The agreement may cover hours of care per day, week, or month; cost of care per day, week, or month; frequency and amount of payment per day, week, or month; and any special services to be .
3. The provider did not ensure to obtain a record with any of the required information for child #3 (enrollment date unknown).
4. The record of child #4 (enrollment date: 6/4/2021) did not contain the following required information: did not contain the following required information: Address, Gender, the name of the parent's hospitalization plan and number or medical assistance plan, if applicable; Disclosure to administer/not administer medication; Permission for field trips; names of persons authorized to visit or call for the child, as well as those who are not to visit or call for the child; any written agreement made between the family day provider and the natural parent, guardian, or other responsible person for each child in care. The agreement may cover hours of care per day, week, or month; cost of care per day, week, or month; frequency and amount of payment per day, week, or month; and any special services to be .

Plan of Correction: Not available online. Contact Inspector for more information.

Standard #: 8VAC20-850-110-C
Description: Based on observations, documentation review and interview, the provider did not meet all the
criteria on the health and safety checklist at the time of the inspection.
Evidence:
During the May 16, 2023 the following was observed:
1. The record of child #3 (enrollment date unknown) did not I have a medical release form from the family to permit emergency care.
2. The record of child #2, child #3 and child #4 did not have documentation of a copy of physical examination results. The record of child #3 did not have documentation of immunizations.
3. The provider did not ensure to take steps to safeguard their home from open and obvious household hazards: a. The provider had a large television on the floor, leaning against the wall which presented an injury hazard if pulled by a child. b. The provider's bathroom had a cleaning agent within the reach of children in care. c. There was a bottle of cologne sitting on a table within the reach of children in care. d. There were several used tobacco products
and ashes located on the provider's counter top within the reach of children in care.

Plan of Correction: Not available online. Contact Inspector for more information.

Disclaimer:
This information is provided by the Virginia Department of Social Services, which neither endorses any facility nor guarantees that the information is complete. It should not be used as the sole source in evaluating and/or selecting a facility.


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