VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Greenspring Village
7470 Spring Village Dr
Springfield, VA 22150
(703) 923-4663

Current Inspector: Alexandra Roberts (804) 845-6956

Inspection Date: Feb. 17, 2022

Complaint Related: No

Areas Reviewed:

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 ACCOMODATIONS AND RELATED PROVISIONS 22VAC40-73 BUILDING AND GROUNDS 22VAC40-73 EMERGENCY PREPAREDNESS 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS Article 1 Subjectivity 63.2 General Provisions. 63.2 Protection of adults and reporting. 63.2 Licensure and Registration Procedures 63.2 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.

Comments:

An unannounced renewal study was conducted on 12/23/2021. At the time of entrance 148 residents were in care. The sample size consisted of ten resident records and five staff records. Resident and staff records and other documentation reviewed. Criminal Background Checks of all staff hired since previous inspection were reviewed. Residents were observed eating lunch and engaging in activities. Medication administration was observed with one staff and PRN medications for residents observed. Building and Grounds observed. Additional documentation requested by email. Violation notice issued, risk ratings reviewed and exit interview held. Violation notice issued and exit interview held during virtual interview. Areas of non-compliance are identified on the violation notice. Please complete the "plan of correction" and "date to be corrected" for each violation cited on the violation notice and return to the licensing office within 10 calendar days. Please specify how the deficient practice will be or has been corrected. Just writing the word "corrected" is not acceptable. The plan of correction must contain: 1) steps to correct the non-compliance with the standard(s), 2) measures to prevent the non-compliance from occurring again, 3) person(s) responsible for implementing each step and/or monitoring any preventative measure(s), and 4) date that that plan of correction will be completed. Thank you for your cooperation and if you have any questions please call (703) 895-5627 or contact me via e-mail at jeannette.zaykowski@dss.virginia.gov.

Violations:

Standard #:	22VAC40-73-640-A
Description:	Based on observation, the facility failed to ensure that the facility shall implement a written plan for medication management and shall address procedures for administering medication that include methods to ensure that each resident's prescription medications and any over-the-counter drugs and supplements ordered for the resident are filled and refilled in a timely manner to avoid missed dosages. EVIDENCE: During observation of medication administration with Staff 1 on 12/23/2021, four of Resident 3's medications (Aspirin 81 mg, Lexapro 20 mg, Vitamin B1 100 mg, and Vitamin D3 2000 unit) were not available.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-660-A-1
Description:	Based on observation, the facility failed to ensure that the storage area for medications shall be locked. EVIDENCE: On 12/23/2021, 1. During observation of building and grounds, Licensing Inspector observed Rivastigmine Transderma L system 9.5 mg and scissors in an unlocked medication cabinet in Resident 4's safe, secure room. 2. During observation of medication administration with Staff 1, Licensing Inspector observed Staff 1: a. walk away from Resident 1's medication left in a cup on the computer to go to the Resident's bathroom for a cup of water; b. walk away from Resident 2's medication left in a cup on the computer cart to go to the Resident's bathroom for a cup of water; c. walk away from Resident 3's medication left in a cup on the computer to walk into the resident's room and to a medication cart in the hallway to look in the cabinets for additional medications.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-680-C
Description:	Based on observation, facility failed to ensure that medications shall be administered not earlier than one hour before and not later than one hour after the facility's standard dosing schedule. During medication observation with Staff 1 on 12/23/2021, Licensing Inspector observed the following: 1. Resident 1's medications were administered at 10:25 a.m. and Resident 1's MAR shows the scheduled times for Aspercreme patch at 8:00 a.m. and Gabapentin 300 mg at 9:00 a.m. 2. Resident 2's medication was administered at 10:55 a.m. and Resident 2's MAR shows the scheduled times for Vitamin D3 125 mcg at 9:00 a.m. and Effexvor XR 75 mg at 9:00 a.m. 3. Resident 3's medication was administered at 11:20 a.m. and Resident 3's MAR shows the scheduled time for SEROquel 25 mg at 10:00 a.m.
Plan of Correction:	Not available online. Contact Inspector for more information.