VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Avalon House on Gelston Circle
1011 Gelston Circle
Mc lean, VA 22102
(301) 656-8823

Current Inspector: Alexandra Roberts (804) 845-6956

Inspection Date: Nov. 15, 2021

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 ACCOMODATIONS AND RELATED PROVISIONS 22VAC40-73 BUILDING 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.

Comments:

An unannounced renewal inspection was conducted on 11/15/21 (8:15 AM - 11:45 AM). At the time of entrance, seven residents were in care. A meal and medication administration were observed. Building and grounds were inspected and records were reviewed. The sample size consisted of four resident records and three staff records. Violations were discussed and an exit meeting was held. 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 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 #:	22VAC40-73-640-A
Description:	Based on observation and record review, the facility failed to implement the written plan for medication management. Evidence: The facility's medication management plan states that medications will be checked on a daily basis to remove any outdated, damaged, or contaminated medications. Brimonidine-Timolol eye drops were observed with Resident #1's medications. The expiration date listed on the eye drops was 02/2021. No other Brimonidie-Timolol eye drops were present for Resident #1 to take, during the inspection. The medication management plan states that MAR records will be checked against physician's orders daily. Resident #1's November MAR called for her to receive a 1mg tablet of Bumetanide daily. Resident #1's physician's order for Bumetanide, dated 11/1/21, calls for the resident to receive 0.5mg of Bumetanide daily.
Plan of Correction:	Facility will continue to follow the medication management plan. RN will work with the Medication Technician and review the med. management plan as well as the importance of medications being administered in accordance with physician's orders. Spot checks by RN will be done during RN visits.
Standard #:	22VAC40-73-680-D
Description:	Based on observation and documentation, the facility failed to ensure that medications are administered in accordance with the physician's instructions and consistent with the standards of practice outlined in the current registered medication aide curriculum approved by the Virginia Board of Nursing. Evidence: Medication administration for Resident #1 was observed during the inspection. Resident #1 was given a 1mg tablet of Bumetanide during the medication observation. The physician's order for Resident #1's Bumetanide, dated 11/1/21, calls for the resident to receive 0.5mg of Bumetanide daily.
Plan of Correction:	Expired medication checks will also be done by RN. RN will work with the medication technician and review the importance of medications being administered in accordance with physician's orders. Spot checks will be done by RN during RN visits.