VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Spring Hills Mt. Vernon
3709 Shannons Green Way
Alexandria, VA 22309
(703) 780-7100

Current Inspector: Nina Wilson (703) 635-6074

Inspection Date: Oct. 18, 2021

Complaint Related: No

Areas Reviewed:

22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES 22VAC40-73 BUILDING AND GROUNDS

Comments:

On 11/19/2021 through 11/26/2021, Licensing Inspector conducted an inspection in response to a self-reported incident. Reviewed incident reports and other communications with staff. Violation notice issued and assessed risk assigned to violations reviewed during the exit interview. Exit interview conducted on 11/29/2021 with the Regional Executive Director and the violation notice regarding the standards deemed valid was emailed for correction. 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 #:	22VAC40-73-70-C
Description:	Based on documentation, facility failed to submit a written report of each incident within seven days from the date of the incident and the report shall be signed and dated by the administrator and include the following information: Name and address of the facility; Name of the resident or residents involved in the incident; Date and time of the incident; Description of the incident, the circumstances under which it happened, and when applicable, extent of injury or damage; Location of the incident; Actions taken in response to the incident; Actions to prevent recurrence of the incident, if applicable; Name of staff person in charge at the time of the incident; Names, telephone numbers, and addresses of witnesses to the incident, if any; and Name, title, and signature of the person making the report, if other than the administrator, and date of the completion of the report. EVIDENCE: Facility Executive Director emailed an initial report to the Licensing Inspector on 10/17/2021 that stated "issues with the boiler and hot water goes on and off" and did not issue a complete report within seven days from the date of the incident. Emails from the Regional Executive Director were received on 11/19/2021, 11/24/2021 and 11/26/2021 regarding steps taken at the facility to repair the issues.
Plan of Correction:	Not available online. Contact Inspector for more information.