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: June 18, 2024

Complaint Related: No

Areas Reviewed:

Inspection Type: Monitoring Unannounced 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: 06/18/2024: 08:30 to 14:00 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: 6. Number of staff records reviewed: 3. Number of interviews conducted with residents: 2. 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 #:	22VAC40-73-450-E
Description:	Based on the record review and staff interview, the facility failed to ensure the individualized service plan (ISP) was signed by the resident and/or their legal representative. Evidence: 1. Resident 3?s individualized service plan (ISP) dated 01/09/2024, is not signed or dated by the resident, resident?s legal representative, or the facility. 2. Staff 4 confirmed the ISP is unsigned by the resident, and or the resident?s legal representative.
Plan of Correction:	In respect to the specific residents/situations cited: ISP was signed by Resident 3 RP on 6/25/2024. In respect to how the facility will identify residents/situations with the potential for the identified concern: A 100% Audit of Resident?s ISP signature by Resident or legal representative will be conducted. With respect to what systemic measures have been put into place to address the stated concern: A periodic audit of Resident?s ISP?s for Resident or legal representative signature will be conducted by the Director of Clinical Services in addition to our quarterly audits.