VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Vitality Living Arlington
3821 Wilson Boulevard
Arlington, VA 22203
(703) 294-6875

Current Inspector: Alexandra Roberts

Inspection Date: June 21, 2022

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 22VAC40-73 EMERGENCY PREPAREDNESS 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS ARTICLE 1 ? SUBJECTIVITY 32.1 REPORTED BY PERSONS OTHER THAN PHYSICIANS 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

Comments:

Type of inspection: Monitoring Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: LI entered the facility at 8:44 am on 6/21/2022 and exited at 4:40pm on 6/21/2022 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: 105 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 10 Number of staff records reviewed: 5 Number of interviews conducted with residents: 4 Number of interviews conducted with staff: 1 Observations by licensing inspector: LI observed medication administration, residents eating breakfast and residents engaging in activities. Additional Comments/Discussion: There has been a transition in the administrative team in the last few months. 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 Jamie Eddy, Licensing Inspector at (703) 479-5247 or by email at jamie.eddy@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-250-C
Description:	250-C-6 Based upon a review of records, the facility failed to ensure that the following information is maintained on staff and included in the staff records: an original criminal record report. Evidence: The staff records for Staff #4 and Staff #5 did not contain a criminal record report.
Plan of Correction:	All potential employees will have background checks obtained prior to start of employment. BOD will do monthly random employee file audits to monitor for compliance.
Standard #:	22VAC40-73-260-A
Description:	260-A-1 Based upon a review of records, the facility failed to ensure that each direct care staff shall maintain current certification in first aid from the American Red Cross, American Heart Association, National Safety Council, American Safety and Health Institute, community college, hospital, volunteer rescue squad or fire department. Evidence: The staff record for Staff #1, #3, and #5 did not contain evidence of current first aid certification.
Plan of Correction:	All direct care staff employee files will be audited for proof of First Aid, and those associates that are not current will complete the training by 7/31/2022. Staff #1, #3, and #5s proof of completion has been added to their files. BOD will do monthly random employee file audits to monitor for compliance.
Standard #:	22VAC40-73-720-A
Description:	720-A-2 Based upon a review of records, the facility failed to ensure that Do Not Resuscitate (DNR) Orders for withholding cardiopulmonary resuscitation from a resident in the event of cardiac or respiratory arrest are included on the individual service plan (ISP). Evidence: According to the medical records, Resident #2, Resident #6, Resident #7, and Resident #8 have DNR orders. The Individualized Service Plans (ISPs) for Resident #2, Resident #6, Resident #7, and Resident #8 do not include DNR status.
Plan of Correction:	All current resident ISPs will be reviewed and the designation of DNR status will be added to those who have proper supporting documentation in place. DOW will do monthly random chart audits to monitor for compliance.
Standard #:	22VAC40-90-30-B
Description:	40-90-30-B Based upon a review of records, the facility failed to ensure that the sworn statement or affirmation shall be completed for all applicants for employment. Evidence: The sworn statement or affirmation documents in the staff files of the following staff members were either not signed or not completed in full: Staff #8, Staff #12, Staff #19, Staff #37 Staff #39, Staff #41, Staff #42, and Staff #43
Plan of Correction:	All current employee files will be audited for missing sworn statements of attestation. HR will obtain sworn statements of attestation for: Staff #8, Staff #12, Staff #19, Staff #37, Staff #39, Staff #41, Staff #42, and Staff #43 by 7/31/2022. BOD will do monthly random employee file audits to monitor for compliance.