VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Aarondale Retirement & Assisted Living Community
6929 Matthew Place
Springfield, VA 22151
(703) 813-1800

Current Inspector: Jacquelyn Kabiri (703) 397-3017

Inspection Date: May 18, 2024

Complaint Related: No

Areas Reviewed:

Inspection Type: Monitoring Unannounced Non-mandated Areas of Standards Reviewed: MARK AREAS REVIEWED AREAS OF STANDARDS ? 22VAC40-73 GENERAL PROVISIONS ? 22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES ? 22VAC40-73 PERSONNEL ? 22VAC40-73 STAFFING AND SUPERVISION ? 22VAC40-73 ADMISSION, RETENTION AND DISCHARGE OF RESIDENTS ? 22VAC40-73 RESIDENT CARE AND RELATED SERVICES ? 22VAC40-73 RESIDENT ACCOMMODATIONS AND RELATED PROVISIONS ? 22VAC40-73 BUILDINGS AND GROUND ? 22VAC40-73 EMERGENCY PREPAREDNESS ? 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS ? ARTICLE 1 ? SUBJECTIVITY ? 32.1- (37) REPORTED BY PERSONS OTHER THAN PHYSICIANS ? 63.2- (1) GENERAL PROVISIONS ? 63.2- (16) PROTECTION OF ADULTS AND REPORTING ? 63.2- (17) LICENSURE AND REGISTRATION PROCEDURES ? 63.2- (18) FACILITIES AND PROGRAMS ? 22VAC40-90 BACKGROUND CHECKS FOR ASSISTED LIVING FACILITIES ? 22VAC40-90 THE SWORN STATEMENT OR AFFIRMATION ? 22VAC40-90 THE CRIMINAL HISTORY RECORD REPORT ? 22VAC40-80 THE LICENSE ? 22VAC40-80 THE LICENSING PROCESS ? 22VAC40-80 COMPLAINT INVESTIGATION ? 22VAC40-80 SANCTIONS

Comments:

Type of inspection: Monitoring Date of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 05/16/2024: 8:30 AM to 2:00 PM. 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: 57. The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 3. Number of staff records reviewed: 3. Number of interviews conducted with residents: 0 Number of interviews conducted with staff: 1. Observations by licensing inspector: Meals, Activities, Medication Pass An exit meeting will be conducted to review the inspection findings. The evidence gathered during the inspection determined noncompliance with applicable standard(s) or law, and violations 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 #:	22VAC40-73-70-A
Description:	Based on record review, the facility failed to report to the regional licensing office within 24 hours of any major incident that has negatively affected or that threatens the life, health, safety, or welfare of any resident. Evidence: 1. The Department received an incident report on 4/29/2024 regarding Resident 1. The incident report noted that the incident occurred on 4/27/2024. 2. The Department received an incident report on 4/29/2024 regarding Resident 2. The incident report noted that the incident occurred on 4/26/2024.
Plan of Correction:	In respect to the specific resident/situation cited: The Community is up to date with all Reportable Incidents. In respect to how the facility will identify residents/situations with the potential for the identified concerns: The Director of Clinical Services or designee will complete an audit of all resident records to verify all appropriate incidents are reported accordingly. With respect to what systemic measures have been put into place to address the stated concern: Refresher In-service to be completed with Wellness team on incident reporting.
Standard #:	22VAC40-80-120-E-2
Description:	Based on observation and staff interview, the facility failed to ensure that ?certain documents related to the terms of the license were posted on the premises to include the findings of the most recent inspection of the facility. Evidence: 1. The LI observed the bulletin board located adjacent from the ladies room in the back of the entrance lobby that contained a note that stated, "Most recent inspection available at the Front Desk." 2. A request was made to Staff 3 at the front desk of the location for the most recent inspection findings. 3. Staff 3 did not know what or where the most recent licensing inspection notes were located. 4 .Staff 4 located a red binder, in the desk drawer and provided it to the inspector. 5. Staff 4 placed the binder by the computer sign in, when requested. 6. Upon exiting the facility, the red binder was no longer in view at the front desk and had been placed back in the drawer behind the front desk.
Plan of Correction:	In respect to the specific resident/situation cited: Most recent DSS Inspection was posted in display stand located by the Concierge?s Desk. With respect to what systemic measures have been put into place to address the stated concern: In-service to be completed with the Concierge Team and all Managers on Duty to re-train on the protocol for posting inspection results post DSS survey.