VIRGINIA DEPARTMENT OF SOCIAL SERVICES

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

Current Inspector: Alexandra Roberts

Inspection Date: June 17, 2024

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 22VAC40-90 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 Inspection Date of Inspection: June 17th 2024 thru June 18th 2024 - 8am - 4:30pm 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: 144 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 4 Number of staff records reviewed: 4 Number of interviews conducted with residents: 1 Number of interviews conducted with staff: 1 Observations by licensing inspector: The LI observed medication administration, residents eating lunch and participating in activities. LI spoke with 1 family member present during the inspection. An exit meeting will be conducted to review the inspection findings. The evidence gathered during the initial inspection determined non-compliance with applicable standard(s) or law, and violation(s) were documented on the violation notice issued to the facility. The applicant has the opportunity to submit a plan of correction to indicate how the cited violation(s) will be addressed in order to maintain future compliance with applicable standard(s) or law. If the applicant 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 should the facility be issued a license to operate. 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 a licensed facility. For more information about the VDSS Licensing Programs, please visit: www.dss.virginia.gov Should you have any questions, please contact Alexandra Roberts, Licensing Inspector at 804-845-6956 or by email at Alexandra.n.roberts@dss.virginia.gov.

Violations:

Standard #:	22VAC40-73-320-A
Description:	Based on record review, facility failed to ensure that a person shall have a physical examination by an independent physician. The report of such examination shall be on file at the assisted living facility and shall contain all required components. Evidence: 1. Resident 4?s physical examination report dated 12/12/23 was missing ambulatory or non-ambulatory status, address, and date of birth.
Plan of Correction:	Resident mentioned in report physical exam was updated by Nurse Practitioner. DOW will audit current resident H&P for required information. Going forward Director of Wellness or designee will review state required paperwork prior to admission.
Standard #:	22VAC40-73-390-C
Description:	Based on record review, facility failed to ensure that resident agreements shall be updated whenever there are changes that are dated and signed by the licensee or administrator as well as the resident or their legal representative. Evidence: 1. Staff 5 provided LI the updated and revised resident agreement dated as being revised on 02/09/2024. Resident agreement was updated in March of 2023 and then again on 02/09/2024. 2. Resident 1?s resident agreement was signed and dated 05/21/22. 3. Resident 2?s resident agreement was signed and dated 09/12/22. 4. Resident 4?s resident agreement was signed and dated 12/12/23. 5. Staff 2 and 5 stated that they were unaware that resident agreements needed to be updated and re-signed when revisions are made.
Plan of Correction:	Director of Business will audit current resident files for the most current version of the community agreement, complete with all required party signatures. For new admissions; agreements will be reviewed prior to admission by the ED.
Standard #:	22VAC40-73-950-F
Description:	22VAC40-73-950-F Based on record review and staff interview, the facility failed to review the emergency preparedness plan annually or more often as needed. The review shall be documented by signing and dating. Evidence: 1. Emergency preparedness plan was updated on 01/01/2024. There was no documentation that updates were communicated to staff or residents for the semi-annual review. 2. Staff 2 confirmed that facility does not have a documented semi-annual log of training for staff and/or residents on the plan.
Plan of Correction:	Training put in place for Residents and staff. Training for Residents will take place at Resident Council every third Wednesday of the month. Staff training happens monthly as well at the Town Hall . Last resident council was 6/26/24, next one will be 7/24/24. Town Halls will complete staff trainings needed in Emergency Preparedness ? next one is 7/18/24. ED will randomly review attendee sign in sheets for resident and staff compliance.
Standard #:	22VAC40-73-980-A
Description:	22VAC40-73-980-A Based on observation and staff interview, the facility failed to ensure a complete first aid kit is on hand. Evidence: 1. First aid kit on hand did not include: Plastic bags, disposable blankets, flashlight, batteries, or a thermometer or breathing barriers. 2. Staff 5 & Staff 2 stated that they did not know that the additional items were needed for first aid kit on hand.
Plan of Correction:	Items missing have been purchased and replaced and placed in designated area. All staff trained in Town Hall and documented attendance. Director of Wellness and Executive Director will audit randomly.
Standard #:	22VAC40-73-980-C
Description:	Based on record review and staff interview, facility failed to ensure month first aid kits are checked at least monthly to ensure all items are present. Evidence: 1. LI requested documentation from staff 6 who maintains the first aid kit. Staff 6 informed that she does not complete documentation for first aid kit and would ask Staff 2. 2. Staff 2 confirmed that facility does not have a monthly check/documentation to provide and has not been completed.
Plan of Correction:	Log in place effective immediately. Log is monitored by Director of Wellness and Assistant Director of Wellness monthly. Executive Director will monitor quarterly.