VIRGINIA DEPARTMENT OF SOCIAL SERVICES

NOVA Adult Day Care Center Inc.
44675 Cape Court
Suite 130
Ashburn, VA 20147
(703) 433-8888

Current Inspector: Amanda Velasco (703) 397-4587

Inspection Date: Aug. 1, 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

Technical Assistance:

Health Inspection Requirements discussed.

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: 08/01/2024 8:20 AM to 12:15 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: 68 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of participant records reviewed: 5 Number of staff records reviewed: 3 Number of interviews conducted with participants:0 Number of interviews conducted with staff: 3 Observations by licensing inspector: Breakfast, Activities. Additional Comments/Discussion: N/A 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 Amanda Velasco, Licensing Inspector at (703) 397 4587 or by email at Amanda.Velasco@dss.virginia.gov

Violations:

Standard #:	22VAC40-61-150-A
Description:	Based on staff record review and staff interview, the facility failed to ensure that all staff who provide direct care attended at least 12 hours of training annually. Evidence: 1. The annual training logs for Staff 1 and 3 were requested. 2. Staff 4 stated that the annual training was not done.
Plan of Correction:	The Director shall work with all direct care staff to attend at least 12 hours of training annually- Ongoing.
Standard #:	22VAC40-61-180-E-1
Description:	Based on direct observation from two licensing inspectors and staff interview, the facility failed to ensure that each staff person obtained an evaluation for tuberculosis (TB) in a communicable form no earlier than 30 days before and no later than 7 days after employment or contact with participants. Evidence. 1. Staff 1, hired 03/25/2024, had a chest x-ray conducted on 05/23/2021. Staff 1 did not have a TB screening conducted no earlier than 30 days before or 7 days after employment. 2. Staff 4 stated they did not have a more recent TB test or screening.
Plan of Correction:	All newly hired employees will submit a TB screening no earlier than 30 days or 7 days after employment. Ongoing.
Standard #:	22VAC40-61-180-E-2
Description:	Based on staff record review and staff interview, the facility failed to ensure that all staff were screened annually in accordance with subdivision 1 of this section. Evidence. 1. Staff 4, hired on 11/12/2019, had a chest x-ray conducted on 11/15/2022. Staff 4?s did not have a more recent annual Tuberculosis screening. 2. Staff 4 stated that the screening was not completed because they had not been feeling well.
Plan of Correction:	All staff had updated TB screening completed.
Standard #:	22VAC40-61-190-A
Description:	Based on direct observation from two licensing inspectors and staff interview, the facility failed to ensure that one staff person on the premises oversaw the administration of the center. This person shall be either the director or a staff member appointed by the licensee or designated by the director. Evidence: 1. Two LI?s entered the building on 08/01/2024 at 8:20 AM and requested to speak to the person in charge. 2. A staff member in the kitchen, no name tag, stated ?Our English is not good, so you can wait. 3. This staff member called Staff 4 who stated they would be on site around 9:30 AM and they would send an office staff member to help us sooner. 4. The LI?s tried to clarify if any of the staff in the building were managers but were unsuccessful. There were two staff in the kitchen, as well as a few bus drivers that were in and out of the building all stated that they were not the manager. 5. Staff 2 arrived and stated that they would assist until someone arrived; however, he did not have access to certain files. When asked about who the manager on duty was, Staff 2 stated that it was one of the bus drivers, but they did not speak English so they would help translate. 6. Staff 4 later confirmed that the program hours are 8 AM to 2 PM, but the office staff come from 9 AM to 5 PM.
Plan of Correction:	The facility has designated an alternate manager to be on site to oversee the administration of the facility when the Director is not available.
Standard #:	22VAC40-61-250-B
Description:	Based on resident record review, the facility failed to ensure that the following information be kept current for each participant: a current photograph or narrative physical description of the participant, which should be updated annually. Evidence: 1. The records for Participants 1, 2, 5 and 6 did not contain an updated photo identification. 2. Participant 1, 2, and 6?s records contained their state issued IDs issued on the following dates: a. Participant 1?s, admitted 04/06/2022, photo identification was issued 04/02/2018. b. Participant 2?s, admitted 02/15/2024, state identification card was issued 11/13/2023. c. Participant 6?s, admitted 05/06/2022, state identification card was issued on 02/03/2020. 3. Staff 4 confirmed they did not have updated photos for Participants 1, 2, 5 and 6.
Plan of Correction:	The facility was transitioning to digital records beginning the third quarter of 2023 and had photos taken of each participant for their ID cards. These photos were stored electronically at the time of the inspection. The facility shall annually update photos in participant records moving forward. Updated participant photos have been added to their records.
Standard #:	22VAC40-61-330-G-5
Description:	Based on direct observation from two licensing inspectors and staff interview, the facility failed to ensure that the current month?s activity schedule was posted in a readily accessible location in the center. Evidence: 1. The facility had a daily activity schedule posted. 2. Staff 4 provided an example of previous monthly activity calendars completed to confirm what the LI?s requested. 3. Staff 4 confirmed there was not a monthly activity schedule posted. 4. Photo evidence obtained.
Plan of Correction:	Monthly and Daily activity schedules shall be posted in an easily accessible location in the center.
Standard #:	22VAC40-61-360-B
Description:	Based on direct observation from two licensing inspectors and staff interview, the facility failed to ensure that menus for meals and snacks for the current week were dated and posted in an area conspicuous to participants. Evidence: 1. The facility did not have a weekly menu posted. 2. Staff 2 and 4 stated that the weekly menu was sent to the kitchen staff, and they had access on the phones.
Plan of Correction:	Weekly menus for meals and snacks shall be posted in an area conspicuous to participants.
Standard #:	22VAC40-61-410-E
Description:	Based on direct observation, the facility failed to ensure that cleaning products, pesticides, and all poisonous or harmful materials shall be stored separately from food and kept in a locked place when not in use. Evidence: 1. The center provides care to participants with dementia. 2. To the right of the front door, a bottle of ?bed bug killer? was observed next to the plants. 3. In the women?s bathroom, a bottle of toilet bowl cleaner was observed in one of the stalls. 4. In the women?s bathroom, under the sink on the floor, a bottle of spray Lysol and ?Pet Solutions? cleaner were observed. 5. On the side table by the offices, a container of Clorox wipes was observed. 6. Photo evidence obtained.
Plan of Correction:	All cleaning products, pesticides, and all poisonous or harmful materials were removed from cited places and stored in a locked cleaning closet after LIs left the facility.
Standard #:	22VAC40-80-120-E-2
Description:	Based on direct observation from two licensing inspectors, the facility failed to ensure that the findings of the most recent inspection of the facility were posted in each facility. Evidence: 1. The facility did not have the most recent inspection summary posted, or a copy of any previous inspections posted in the facility.
Plan of Correction:	The findings of the most recent inspection of the facility shall be posted.