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: July 15, 2024

Complaint Related: No

Areas Reviewed:

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 63.2- (1) GENERAL PROVISIONS 63.2- (17) LICENSURE AND REGISTRATION PROCEDURES 22VAC40-90 BACKGROUND CHECKS FOR ASSISTED LIVING FACILITIES 22VAC40-90 THE SWORN STATEMENT OR AFFIRMATION 22VAC40-90 THE CRIMINAL HISTORY RECORD REPORT

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: 7/15/2024, 12:00 pm-2:45 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: 93 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of participant records reviewed: 6 Number of staff records reviewed:5 Number of interviews conducted with participants: 0 Number of interviews conducted with staff: 2 Observations by licensing inspector: Lunch and activities. 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 Jacquelyn Kabiri, Licensing Inspector at (703) 397-3017 or by email at Jacquelyn.Kabiri@dss.virginia.gov

Violations:

Standard #:	22VAC40-61-190-C
Description:	Based on record review and staff interviews, the facility failed to maintain a daily participant attendance log, documenting participant arrival times and departure times. Based on record review and staff interviews, the facility failed to maintain a daily participant attendance log, documenting participant arrival times and departure times. Evidence: 1. Staff 1 stated the census was ?92 to 93 to 95?. 2. Staff 1 stated that they complete the attendance at the end of the day based on observation. 3. Staff 1 provided the attendance and meal count logs. 4. The attendance and meal count logs from July 08 through 12th of 2024, indicated the meals served but did not include arrival or departure times. 5. Staff 1 acknowledged that the logs do not indicate the arrival or departure times.
Plan of Correction:	Submitted a daily participant attendance log, recording participants? arrival times and departure times.
Standard #:	22VAC40-61-300-E-3
Description:	Based on observations made during the tour, the facility failed to keep medication in a locked compartment or area that is not accessible to participants. Evidence: 1. Monthly pill planner box, a bottle of aspirin 81mg and triamcinolone acetonide cream 0.5% were in an unlocked cabinet, located in the facility?s main-level tea service area. 2 Staff #2 acknowledged the medications were stored in an unlocked cabinet. 3. Photos taken as evidence.
Plan of Correction:	The center director will conduct a training session with staff to ensure that medication is stored in a locked area that is inaccessible to participants.
Standard #:	22VAC40-61-410-A
Description:	Based on direct observation, the center failed to ensure the interior and exterior of all buildings were maintained in good repair, kept clean and free of rubbish, and free from safety hazards. Evidence: 1. Adjacent to the kitchen the storage door had 3 large holes in the surface. 2. During a tour of the facility, four chairs were observed in the dining area with peeling and torn fabric. 3. The floor walkway area to the kitchen appeared dirty, dusty, and had electrical cords with silver duct tape across them. 4. The ceiling above the ping pong table had 2 large squares cut out of the ceiling. There were also watermarks on the ceiling. 5. Photos taken as evidence.
Plan of Correction:	The center director will ensure that facility is properly maintained and kept clean.
Standard #:	22VAC40-61-410-E
Description:	Based on observations made during a tour of the building, the facility failed to ensure cleaning products, pesticides, and all poisonous or harmful materials shall be kept in a locked place when not in use. Evidence: 1. In the unlocked bathroom/storage room next to the kitchen, there were 3 large plastic jugs of Clorox bleach, 3 bottles of Pine Sol, 1 bottle of easy-off oven cleaner, and 2 cans of WD-40. 2. in the men?s lounge a sharps hazard container with unknown sharps, was found behind the TV on the Located shelf. 3. Staff 2 removed the container of sharps stating she was unaware it was there. 4. Photos taken as evidence.
Plan of Correction:	The center director will conduct a training session with staff to ensure that cleaning products, and harmful materials stored in a locked area when not in use.
Standard #:	22VAC40-61-550-B
Description:	Based on direct observation and staff interviews the center failed to ensure first aid kits were in a designated place accessible to staff but not accessible to participants. Evidence: 1. A request was made to review the first aid kit with Staff 1. 2. Staff 1 checked two separate cabinets on the main level of the facility. 3. Staff 1stated that they only had first aid kits in the facility vehicles, and the facility vehicles were out on drop-offs at the time of request.
Plan of Correction:	We have purchased 15 kits and placed them on each floor of the building as well as in the vehicles. Additionally, we have trained the staff on how to use them.