VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Lincolnia Adult Day Health Care Center
4710 North Chambliss St
Alexandria, VA 22312
(703) 914-0330

Current Inspector: Nina Wilson (703) 635-6074

Inspection Date: June 27, 2024

Complaint Related: No

Areas Reviewed:

22VAC40-61 GENERAL PROVISIONS 22VAC40-61 ADMINISTRATION 22VAC40-61 PERSONNEL 22VAC40-61 SUPERVISION 22VAC40-61 ADMISSION, RETENTION AND DISCHARGE 22VAC40-61 PROGRAMS AND SERVICES 22VAC40-61 BUILDINGS AND GROUND 22VAC40-61 EMERGENCY PREPAREDNESS

Comments:

Type of inspection: Monitoring Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 06/27/2024 Time In: 9:24 AM Time Out: 10:58 AM Time In: 11:14 AM Time Out: 1:04 PM The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. Number of participants present at the facility at the beginning of the inspection: 19 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of participant records reviewed: 2 Number of staff records reviewed: 2 Number of interviews conducted with participants: 1 Number of interviews conducted with staff: 3 Observations by licensing inspector: LI observed the physical plant of the facility. LI observed the participants watching television together, dining at lunch, exercising, reading a book, and entering, and exiting the facility for the day. Additional Comments/Discussion: An exit meeting will be conducted to review the inspection findings. The evidence gathered during the inspection determined non-compliance with applicable standard(s) or law, and violation(s) were documented on the violation notice issued to the facility. The licensee has the opportunity to submit a plan of correction to indicate how the cited violation(s) will be addressed in order to return the facility to compliance and maintain future compliance with applicable standard(s) or law. If the licensee wishes to provide a plan of correction: (i) type the plan on a separate Word document, (ii) identify the standard violation number being addressed, (iii) include the date the violation will be corrected, (IV) do not include any names or confidential information, and (V) return to the licensing inspector by email within five (5) business days of the exit interview. Compliance with all applicable regulations and law shall be maintained and any areas of noncompliance must be corrected. Within 15 calendar days of your receipt of the inspection findings (inspection summary, violation notice, and supplemental information), you may request a review and discussion of these findings with the inspector's immediate supervisor. To make a request for review and discussion, you must contact the licensing supervisor at the regional licensing office that serves your geographical area. Regardless of whether a supervisory review has been requested, the results of the inspection will be posted to the DSS public website within 5 business days of your receipt of the Inspection Summary and/ or Violation Notice. The department's inspection findings are subject to public disclosure. Please Note: A copy of the findings of the most recent inspection are required to be posted on the premises of the facility. For more information about the VDSS Licensing Programs, please visit: www.dss.virginia.gov Should you have any questions, please contact Nina Wilson, Licensing Inspector at (703) 635-6074 or by email at Page 4 of 9 nina.wilson@dss.virginia.gov

Violations:

Standard #:	22VAC40-61-410-E
Description:	Based on facility observation, the facility failed to ensure that cleaning products, pesticides, and all poisonous or harmful materials shall be stored separately from food and shall be kept in a locked place when not in use. Evidence: 1. On 06/27/2024, LI toured the bathroom and noticed that the cabinet was unlocked, which stored personal hygiene items and cleaning products. 2. On 06/27/2024, LI conducted an exit interview with Staff 3, who stated ?the cabinet is always closed.? LI and Staff 3 walked to the bathroom and observed that the cabinet was unlocked. Staff 3 stated, ?staff is cleaning the bathroom. I am sure that she is in the men?s bathroom.? LI stepped out of the bathroom and observed Staff 9 locking the cabinet located in the men?s restroom. Staff 3 stated that the cabinet was unlocked, and Staff 9 stated, ?I was coming back to lock it.?
Plan of Correction:	e. What did you do to fix this specific violation? All staff were educated to always lock the bathroom cabinet after use. f. What steps are you going to implement to ensure future compliance? Before staff walks out of the bathroom, must check to make sure the cabinet is always locked. g. What measures will be put into place to monitor compliance? When completing the participants hourly checks staff will check the bathroom cabinets confirm they are locked and sign off at every hour. h. What date will this be completed by? Education was completed on 7/03/2024