VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Emilia Assisted Living Home
5501 Brookland Road
Alexandria, VA 22310
(703) 971-5205

Current Inspector: Nina Wilson (703) 635-6074

Inspection Date: April 17, 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 GROUND

Technical Assistance:

LI encouraged facility to keep initial and most current documents in resident and staff charts. The facility files away documents in a way that are not easily accessible when needed.

Comments:

Type of inspection: Renewal Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 04/17/2024 Time In: 12:41 pm Time Out: 3:55 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: 7 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: 1 Number of interviews conducted with staff: 1 Observations by licensing inspector: LI toured the physical plant of the facility, and observed residents involved in independent pursuits. Additional Comments/Discussion: 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 Nina Wilson, Licensing Inspector at 703.635.6074 or by email at nina.wilson@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-260-A
Description:	Based on record review and staff interview, the facility failed to ensure that a current certification in first aid is maintained for each direct care staff member. Evidence: Staff 2?s (hire date: 09/20/2017) record contained first aid certification that expired on 01/25/2024.Staff 3?s (hire date:04.07.2022) contained first aid certification that expired on 02/08/2024. On 04/17/2024, LI interviewed Staff 1, who stated that the first aid certifications were expired due to their first aid instructor visiting a different country for an extended period of time. Staff 1 advised that the facility would identify a different instructor if they were unable to schedule with their primary within the week.
Plan of Correction:	What did you do to fix this specific violation? CPR/First aid training was performed a few days after the inspection and new cards have been received for all employees needing CPR/First aid renewal. What steps are you going to implement to ensure future compliance? In case that the renewal falls at the time that the CPR/First Aide instructor is unavailable, Emilia Assisted Living will hire another instructor to maintain compliance. Emilia assisted living will ensure that at least 1 person who is on duty is CPR/first aide certified. What measures will be put into place to monitor compliance? A programmed reminder on excel spreadsheet has been made to track employee record and if update is needed to be made. The person in charge checks this once a month
Standard #:	22VAC40-73-440-A
Description:	Based on a record review, the facility failed to ensure that the Uniform Assessment Instrument (UAI) was completed annually. Evidence: The most recent UAI assessment was for Resident 2, admitted 12/22/2022, was completed on 01/23/2024. Prior to the last assessment date, a UAI was completed on 12/22/2022. On 04/17/2024, LI interviewed Staff 1, who stated that a UAI was completed in 2023 and the documentation was filed in the attic. Staff 1 advised that Resident 2?s 2023 UAI would be emailed to LI. On 04/23/2024, Staff 1 emailed documentation stating that ?the past UAI was created December 2022, it should have been due on December 2023. The reassessment was done on January 2024.?
Plan of Correction:	What did you do to fix this specific violation? The violation was not fixed, although moving forward, the person in charge with the UAI will ensure to re assess the resident not more than a year after the last UAI assessment. What steps are you going to implement to ensure future compliance? The person in charge for the UAI has set up a reminder 30 days before due date to re assess residents. This reminder is placed in an excel spreadsheet which the person in charge checks at least once a month to ensure compliance. What measures will be put into place to monitor compliance? A programmed reminder on excel spreadsheet has been made to remind the person in charge to perform the assessment. The reminder is 30 days before the due date. The person in charge checks this once a month.