VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Youngs Healthcare Senior Center
4215 Evergreen Lane
Annandale, VA 22003
(703) 988-2044

Current Inspector: Jacquelyn Kabiri (703) 397-3017

Inspection Date: Dec. 28, 2022

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 GROUNDS 22VAC40-61 EMERGENCY PREPAREDNESS 22VAC40-80 THE LICENSE. 22VAC40-80 THE LICENSING PROCESS. 22VAC40-80 SANCTIONS. 63.2 General Provisions. 63.2 Protection of adults and reporting. 63.2 Licensure and Registration Procedures 63.2(19.2) Criminal Procedures. 22VAC40-90 Background Checks for Assisted Living Facilities 22VAC40-90 The Sworn Statement or Affirmation 22VAC40-90 The Criminal History Record Report

Technical Assistance:

Please submit a renewal application prior to the current license expiring.

Comments:

An unannounced monitoring inspection was conducted 12/28/2022. At the time of entrance there were approximately 40 participants in care and seven staff members providing supervision. Five participant and two staff records were reviewed. No participants received medications during the inspection. Participants were observed having breakfast. Activities observed included current events, traditional games, yoga, music appreciation and morning exercise. Participant interviews were not conducted because the participants? first language is not English and no interpreters were provided. Violation notice issued with the assessed risk reviewed and exit interview held. 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. 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. Thank you for your cooperation and if you have any questions please call 703-479-4708 or contact me via e-mail at lynette.storr@dss.virginia.gov.

Violations:

Standard #:	22VAC40-61-180-D
Description:	Based on documentation review and interview the facility failed to ensure that documentation of qualifications for employment related to the staff person's position, including any specified relevant information is included in the staff record. Evidence: Staff #1?s record did not include documentation of PCA qualification
Plan of Correction:	Facility has contacted Staff #1 and will obtain a copy of the PCA certificate