VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Vienna Manor II, LLC
1914 Horseshoe Drive
Vienna, VA 22182
(703) 403-7583

Current Inspector: Alexandra Roberts

Inspection Date: Feb. 23, 2023

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.

Technical Assistance:

Documentation was discussed with the provider.

Comments:

An unannounced monitoring inspection was conducted on 2/23/23 (8:10 AM - 11:00 AM). At the time of entrance, eight residents were in care. A meal, medication administration, and an activity 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. 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. For more information about the VDSS Licensing Programs, please visit: www.dss.virginia.gov Should you have any questions, please contact Marshall Massenberg, Licensing Inspector at (703) 431-4247 or by email at m.massenberg@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-680-D
Description:	Based on observation, the facility failed to ensure that medications are administered in accordance with the physician?s or other prescriber?s instructions and consistent with the standards of practice outlines in the current medication aide curriculum approved by the Virginia Board of Nursing. Evidence: Medication administration, for Resident #1, was observed during the inspection. Resident #1 was administered Diclofenac gel on her left hand. Resident #1?s Diclofenac order, dated 10/27/22, calls for the medication to be administered to the resident?s right hand.
Plan of Correction:	As our plan of correction, Vienna Manor Administrator provided a follow-up in-service training with our Medication Aide outlining a detailed process to ensure there is no confusion when administering medication. Correction applied: for clarification purposes, all medications for specific body parts, for example right or left hand, will be placed in a clear plastic bag with the specification written out on the bag for the area the cream is intended for. For example, if a medicated cream for a resident is intended to be administered on the right hand, the cream will be in a clear plastic bag with writing on the bag indicating it is for the right hand.