VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Heatherwood Independent and Assisted Living
9642 Burke Lake Road
Burke, VA 22015
(703) 425-1698

Current Inspector: Jacquelyn Kabiri (703) 397-3017

Inspection Date: June 6, 2024

Complaint Related: Yes

Comments:

Type of inspection: Complaint Date of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 06/06/2024: 4:00 pm to 5:00 pm A complaint was received by the Virginia Department of Social Services, Division of Licensing, on Saturday, 6/1/2024, regarding allegations in the area of: Resident care The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. Number of residents present at the facility at the beginning of the inspection: 111 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 1 Number of staff records reviewed: 2 Number of interviews conducted with residents: 0 Number of interviews conducted with staff: 2. Observations by licensing inspector: Meals, Activities, Medication Pass The evidence gathered during the investigation supported the allegations of noncompliance with standard(s) or law, and violation(s) were issued. Any violation(s) not related to the complaint but identified during the course of the investigation can be found on the violation notice. 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 #:	22VAC40-73-460-B
Complaint related:	No
Description:	Based on resident record review and staff interview, the facility failed to ensure staff promptly responded to resident needs as reasonable to the circumstances. Evidence: 1. Resident 1?s progress notes, dated 5/20/2024 have a communication note written by Staff 2 that states, ?Spoke with wife [ wife?s name] to update her on resident?s current change in condition resident is having more difficulty moving/walking??? 2. During Resident 1?s routine physical therapy visit, it was noted on 5/24/2024 that ??client reports left knee pain with touch or movement ? refuses to attempt to stand and increae (sic) facial grimaces ? notified nursing staff on memory care unit floor as well as 2nd floor nurses station?? 3.There were no progress notes from community staff in Resident 1?s chart from 5/21/2024 to 5/27/2024. 4.[Complainant] stated that they spoke to Resident 1 on 5/20/2024 and Resident 1 shared that it felt like their leg was ?buckling? when standing or walking but was not in pain. 5.Resident 1?s progress note on 5/28/2024 was written by Staff 1 and stated, ?Resident is noted with swollen left knee. Resident 1 said it is painful. Multiple attempt (sic) made to call Resident 1 PCP to request x-ray order and signed POS. Fax also sent out.? 6.Resident 1 had a telehealth appointment on 5/29/2024 and was transported via emergency medical services (EMS) to the hospital on 5/29/2024 per doctor?s recommendations. 7. On 5/30/2024, progress notes written by Staff 1 stated, ?Spoke to wife [Wife] regarding resident status. [Wife] said he is in room 172 cardiac unit. Resident 1 had 2 clots 1 on Resident 1?s left leg and 1 on Resident 1?s lung pressing the heart per [Wife]. [Wife] also said Resident 1 is clear to discharge home on Friday?. 8.Staff 1 stated they were unaware of the initial concern for pain on 5/20/2024. Staff 1 stated that they did not notice swelling or discoloration until 5/28/2024. 9.Staff 1 indicated there were no additional progress notes for resident 1.
Plan of Correction:	In respect to the specific resident/situation cited: DCS and ED have touched base with POA since incident was identified. In respect to how the facility will identify residents/situations with the potential for the identified concerns: DCS has reviewed 24 hour communication with the charge nurse and wellness team to ensure timely communication and follow up of resident events and incidents. With respect to what systemic measures have been put into place to address the stated concern: Residents events and incidents will be reviewed during weekly QA meetings in the next 4 weeks and routinely.
Standard #:	22VAC40-73-460-E
Complaint related:	No
Description:	Based on record review and staff interview, the facility failed to ensure regular observation and documentation of changes. 1.Resident 1?s progress notes, dated 5/20/2024, had a communication note written by Staff 2 that stated, ?Spoke with wife [Wife?s Name] to update her on resident?s current change in condition resident is having more difficulty moving/walking??? 2.Resident 1?s progress note on 5/28/2024 was written by Staff 1 and stated, ?Resident is noted with swollen left knee. Resident 1 said it is painful. Multiple attempt (sic) made to call Resident 1 PCP to request x-ray order and signed POS. Fax also sent out.? 3.There were no progress notes from community staff in Resident 1?s chart from 5/21/2024 to 5/27/2024 documenting changes in the status of the leg concerns. 4.Staff 1 stated that they were not aware of changes in the resident?s condition until 5/28/2024.
Plan of Correction:	In respect to the specific resident/situation cited: DCS and ED have reviewed resident 1 records and have connected with the POA for plan of care. In respect to how the facility will identify residents/situations with the potential for the identified concerns: To ensure timely observation and documentation of changes DCS has reviewed 24 hour communication with the charge nurse and wellness team. With respect to what systemic measures have been put into place to address the stated concern: Residents events and incidents will be reviewed during weekly QA meetings in the next 4 weeks and routinely.