VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Arden Courts (Fair Oaks)
12469 Route 50
Fairfax, VA 22033
(703) 383-0060

Current Inspector: Jacquelyn Kabiri (703) 397-3017

Inspection Date: Feb. 24, 2021

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 RESIDENT CARE AND RELATED SERVICES

Comments:

This inspection was conducted by licensing staff using an alternate remote protocol, necessary due to a state of emergency health pandemic declared by the Governor of Virginia. A complaint inspection was initiated on 2/24/21 and concluded on 4/30/21. A complaint was received by the department regarding allegations in the area of resident care and related services. The administrator was contacted by telephone to conduct the investigation. The licensing inspector emailed the administrator a list of documentation required to complete the investigation. The evidence gathered during the investigation supported the allegation of non-compliance with standards or law, and a violation was issued. Any violations not related to the complaint but identified during the course of the investigation can be found 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 standards, 2) Measures to prevent the non-compliance from occurring again, and 3) Person responsible for implementing each step and/or monitoring any preventative measures. Thank you for your cooperation and if you have any questions, please contact me via e-mail at m.massenberg@dss.virginia.gov.

Violations:

Standard #:	22VAC40-73-460-D
Complaint related:	Yes
Description:	Based on documentation and record review, the facility failed to provide supervision of resident schedules, care and activities including attention to specialized needs. Evidence: Facility documents state that Resident #1 was mistakenly given the COVID-19 vaccine during the resident vaccine clinic on 2/10/21. The resident vaccine clinic took place in the facility's activity room. Staff #1 and two pharmacy employees were present for the resident clinic. The pharmacy employees were provided with the vaccine consent forms for the residents that would be receiving the vaccine. Several residents were also in the activity room, including residents that were not going to be vaccinated. During the clinic, one pharmacy employee left the room in order to get additional vaccine supplies. While the pharmacy employee was out of the room, the other pharmacy employee administered the COVID-19 vaccine to Resident #1. Staff #1 reported that there were no face sheets or resident pictures in the room, to identify which residents had the consent to receive the vaccine. Facility documentation indicates that Resident #1's legal representative was contacted, on 2/9/21, to inquire if the representative wanted Resident #1 to receive the COVID-19 vaccine. The legal representative reported that they decided against Resident #1's vaccination and notified the facility on 2/9/21. Resident #1's ISP (individualized service plan), dated 11/5/20, states that the resident needs total assistance for medications and monitoring health conditions. The record for Resident #1 contained an Assessment of Serious Cognitive Impairment, dated 4/9/19, that states that the resident has a serious cognitive impairment, and that she is unable to recognize danger or protect her own safety and welfare.
Plan of Correction:	CVS did not follow their own protocol in regards to the covid vaccine and gave the vaccine without having the written consent from the family. Community staff will be present and provide supervision during all specialized activities such as vaccines to ensure all resident needs are met.