urn-mm or Facility Name SOCIAL SERVICES Futreil, Tammy Elaine VIOLATION NOTICE Inspection Date 4.19.04 4.i9.04 Findings Review Date Facility Number 1105248 . nnounci Inspect. Type: Initial Monitoring Complaint TraInlConsult Other Una 1 STANDARD DESCRIPTION OF VIOLATION DESCRIPTION OF ACTION TO BE taken NUMBER (Preventative actions Staff ResponSIbIlItIBS) provider has completed 3 hours of will get required trainging hours for daughter- 4?19?04 0-90 training. However. her daughter, who 5 works as her assistant does not have any training hours at this time. provider used a wood burning stove Will get a chimney sweep inspection 4/30/04 0-370 this winter as a primary some of heat. However. a chiminey sweep report was not availible today. Children did not wash their hands Will remember to have children wash hands 4/30/04 0-970 prior to eating breakfast. prior to all meals and snacks. 22VAC40-11 1 child enrolled does not have any will request information from parent 4/ 1 9/04 0-1350 record and has been enrolled since 4.13.04 22VAC40-11 one child does not have the hours will request from parents 4/ 1 9/04 3-1360-1-c which his parents works on ?le 2 children do not have complete Will request information from parents 4/19/04 I-1 360-1?e emergency contact information on file 2VAC40-11 one child does not have information will request information from parents 4/19/04 -1360?1-f regarding who may pick up or visit the child while in care 2 children do not have physical Will request information from parents 4119104 1360-1-j information on ?le 1 of the 2 children does not have immunization information 1 child's enrollement form not signed Will request signature from parent 4119104 360-3-a by parent greed that these violations will be corrected by the dates shown and that compliance will be maintained with all a?ons {acuity represen ive wants further discussion of the findings, a ogrence with the licensi i pector and his 2 1 1 if rctor Signature Represehu?irESt?natur I: A.