VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Home Eldercare
10704 Orchard Street
Fairfax, VA 22030
(703) 273-3640

Current Inspector: Marshall Massenberg (804) 543-5188

Inspection Date: Sept. 27, 2024

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 ACCOMMODATIONS AND RELATED PROVISIONS 22VAC40-73 BUILDINGS AND GROUNDS 22VAC40-73 EMERGENCY PREPAREDNESS 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 22VAC40-80 THE LICENSING PROCESS

Technical Assistance:

Documentation was discussed with the provider. A completed renewal application must be submitted prior to the expiration of the current license. A renewal application can be obtained from the DSS web site.

Comments:

Type of inspection: Renewal Date of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 9/27/24 (8:15 AM - 1:30 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: Six The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 2 Number of interviews conducted with staff: 1 Observations by licensing inspector: meals, medication records, activities An exit meeting will be 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 Marshall Massenberg, Licensing Inspector at (804) 543-5188 or by email at marshall.x.massenberg@dss.virginia.gov.

Violations:

Standard #:	22VAC40-73-320-A
Description:	Based on record review, the facility did not ensure that each resident?s physical examination contained all of the required information. Evidence: Resident #1?s physical examination, dated 7/11/24, did not include the third page of the examination. Resident #2?s physical examination, dated 4/30/24, listed the resident?s allergies but it did not include the resident?s reactions to the allergens.
Plan of Correction:	We missed on one page - trying to get it from the Dr. Aggarwal. Will get the allergies reaction
Standard #:	22VAC40-73-350-B
Description:	Based on record review, the facility did not ascertain, prior to admission, whether a potential resident is a registered sex offender. Evidence: Resident #1?s progress notes indicate that she was admitted to the facility on 7/30/24. Resident #1?s sex offender screening was dated 8/7/24. Resident #2?s progress notes indicate that she was admitted to the facility on 5/3/24. Resident #2?s sex offender screening was dated 5/5/24.
Plan of Correction:	Bali will do the screening before the resident comes to the facility.
Standard #:	22VAC40-73-520-I
Description:	Based on observation and interview, the facility did not ensure that activity schedules for the past two years were present and that the activity schedule includes the hour of each activity. Evidence: Residents were observed exercising and tossing a ball, during the inspection. The activity schedule listed four different activities for 9/27/24, but the hour of each activity was not listed on the schedule. The August and September activity calendars were observed to be present, at the time of the inspection. Facility staff reported that the monthly activity calendars, before August 2024, could not be located.
Plan of Correction:	I really don't understand this violation everyday we do activities morning and evening. Our residents are in their 80s and 90s. We do exercise according to their strengths, we cannot do activities for a hour, due to residents get tired. We will keep all the monthly activities.
Standard #:	22VAC40-73-640-A
Description:	Based on observation and interview, the facility did not ensure that the medication management plan was implemented. Evidence: Resident #1?s Brimonidine Tartrate and Brinzolamide were not present, at the time of the medication storage review. Staff #3 confirmed that the medications were not present, at the time of the medication storage review. PRN medications Levsin and Bisacodyl were ordered, on 7/25/24, for Resident #1. Resident #1?s August MAR did not include her Levsin or Bisacodyl. Staff #3 confirmed that the medications were not included on the August MAR.
Plan of Correction:	Will make sure that the meds will be ordered way before time so that there is no laps and that the resident will have the medication on time and put it in the MAR.
Standard #:	22VAC40-73-680-D
Description:	Based on record review, the facility did not ensure that medications are administered in accordance with the physician?s instructions. Evidence: Resident #1?s record contained orders (dated 9/7/24) for her to receive Morphine and Lorazepam every eight hours. Resident #1?s September medication administration record (MAR) documented that Resident #1?s Morphine and Lorazepam were administered two times per day (8 AM and 4 PM). 2. Facility staff reported that the medications were only administered as documented on the MAR.
Plan of Correction:	We will give the resident medication according to the Dr.'s orders.
Standard #:	22VAC40-73-680-H
Description:	Based on documentation and interview, the facility did not document on the medication administration record (MAR) at the time that medications are administered. Evidence: Staff # 3 reported that the morning medication had been administered for all of the residents at the facility by 8:20 AM, on the date of the inspection. 2. The MAR pages did not include any documentation that the 8 AM medications had been administered to Residents #1-6, at the time of the MAR review. 3. Staff #3 confirmed that the documentation was not completed for Residents #1-6, at the time of the MAR review.
Plan of Correction:	The MAR will be signed at the time giving the meds morning is a very busy time, I will make sure all the meds are signed
Standard #:	22VAC40-73-680-M
Description:	Based on observation and interview, the facility did not ensure that PRN medications are available and properly stored at the facility. Evidence: Resident #1?s record contained an order for PRN Haloperidol, dated 7/25/24. Resident #1?s Haloperidol was not present, at the time of the medication storage review. Staff #3 confirmed that Resident #1?s Haloperidol was not present, at the time of the medication storage review.
Plan of Correction:	We never got the Haloperidol. The hospice ordered it, in spite of me asking them over and over again. It was not sent. We will make sure that all the meds are accounted for.