VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Sunrise Assisted Living at Reston Town Center
1778 Fountain Drive
Reston, VA 20190
(703) 956-8930

Current Inspector: Jacquelyn Kabiri (703) 397-3017

Inspection Date: June 20, 2024

Complaint Related: No

Areas Reviewed:

Administration and Administrative Services Personnel Staffing and Supervision Admission, Retention and Discharge of Residents Resident Care and Related Services Resident Accommodations and Related Provisions Building and Grounds Emergency Preparedness Additional Requirements for Facilities that Care for Adults with Cognitive Impairments Background Checks for Assisted Living Facilities Sworn Statement

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: 06/20/2024 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: 71 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: 4 Number of interviews conducted with residents: 1 Number of interviews conducted with staff: 3 Observations by licensing inspector: Licensing Inspector observed residents eating breakfast and lunch and participating in activity programs. This Licensing Inspector also observed medications being administered to residents. Additional Comments/Discussion: An exit meeting was 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 Sarah Pearson, Licensing Inspector at (540) 680-9469 or by email at sarah.pearson@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-1090-A
Description:	Based on resident record review and staff interview, the facility failed to have an assessment of serious cognitive impairment completed prior to admission to a safe, secure environment. Evidence: Resident 2, admitted to a safe, secure environment on 9/29/2023, had an assessment of serious cognitive impairment completed on 10/2/2023.
Plan of Correction:	A. With respect to the specific resident/situation cited: Resident did not experience any negative outcomes from residing in the reminiscence neighborhood prior to the physician completing the Assessment of Serious Cognitive Impairment form. Form was completed two days after the resident transitioned to memory care. B. With respect to how the facility will identify residents/situations with the potential for the identified concerns: The RCD conducted an audit of current residents? records who were internal transfers to confirm clinical psychologist or physician completed the Assessment for Serious Cognitive Impairment form prior to transition into the reminiscence neighborhood. All forms for Assessment of Serious Cognitive impairment were completed prior to internal transfers to the reminiscence neighborhood except for resident listed in citation. C. With respect to what systemic measures have been put into place to address the stated concern: The RCD or designee will conduct quarterly audits to confirm the Assessment for Serious Cognitive Impairment Form is completed prior to internal transfer from assisted living to the reminiscence neighborhood. Findings will be discussed at quarterly QAPI meeting. The QAPI committee will evaluate the results of the audits after 9 months and determine if additional action is warranted or if the review period needs to be extended. D. With respect to how the plan of correction will be monitored: The Executive Director or designated coordinator is responsible for implementation and ongoing compliance with the components of this Plan of Correction and addressing and resolving variances that may occur.