VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Arden Courts (Annandale)
7104 Braddock Road
Annandale, VA 22003
(703) 256-0882

Current Inspector: Jacquelyn Kabiri (703) 397-3017

Inspection Date: June 13, 2024

Complaint Related: No

Areas Reviewed:

REVIEWED AREAS OF STANDARDS 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 22VAC40-73 EMERGENCY PREPAREDNESS 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENT 32.1- (37) REPORTED BY PERSONS OTHER THAN PHYSICIANS 63.2- (1) GENERAL PROVISIONS 63.2- (16) PROTECTION OF ADULTS AND REPORTING 63.2- (17) LICENSURE AND REGISTRATION PROCEDURES 63.2- (18) 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 22VAC40-80 COMPLAINT INVESTIGATION 22VAC40-80 SANCTIONS

Comments:

Date of inspection: 06/13/2024, 08:40-14:40. Type of inspection: Renewal inspection 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: 51. 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: 7. Number of interviews conducted with residents: 2. Number of interviews conducted with staff: 1. Observations by licensing inspector: Meals, Activities, Medication Pass An exit meeting will be conducted to review the inspection findings. The evidence gathered during the inspection determined noncompliance with applicable standard(s) or law, and violations 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 Jacquelyn Kabiri, Licensing Inspector at (703) 397 3017 or by email at Jacquelyn.Kabiri@DSS.Virginia.gov

Violations:

Standard #:	22VAC40-73-680-B
Description:	Evidence: 1. On 6/13/2024 at 8:30 am, staff 1 was observed conducting a medication pass. Upon inspection of the medication cart, six pre-filled medication cups were observed. 2. The pre-filled medication cups had orange pieces of paper in each cup, with a resident?s name. 3. Photos of the cart and medication cups were taken and shared with staff 9 during the interview.
Plan of Correction:	Staff education and medication pass observation provided. Please see attached staff development education attendance record and, Medication Management, Skills, and Technique evaluation form.
Standard #:	22VAC40-73-700-1
Description:	Based on record review, the facility failed to ensure that a physician?s order included the source of oxygen, such as compressed gas or concentrators, on an oxygen order. Evidence: 1. Resident 6 had a signed physician?s order for oxygen on file. 2. The doctor?s order did not specify concentrator or compressed gas.
Plan of Correction:	All oxygen orders reversed to indicate the source of oxygen. Please see attached revised oxygen orders.
Standard #:	22VAC40-73-870-B
Description:	Based on observation, the facility failed to ensure that the building was well ventilated and free from foul, stale, and musty odors. Evidence: 1. Building and grounds were inspected during the facility walk through. 2. A urine odor was present on the Harvest Glen and Berry Ridge neighborhoods. 3. After looking around the neighborhoods, a bag of resident 7?s clothes were found in a plastic bag in his room, up against a wall.
Plan of Correction:	Rooms identified in both houses were deep cleaned. Please see attached Resident Deep Cleaning Log.