VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Arbor Terrace Sudley Manor
7750 Garner Drive
Manassas, VA 20109
(703) 392-9797

Current Inspector: Sarah Pearson (540) 680-9469

Inspection Date: March 22, 2023

Complaint Related: No

Areas Reviewed:

Personnel Staffing and Supervision Admission, Retention and Discharge of Residents Resident Care and Related Services Resident Accommodations and Related Provisions Building and Grounds Emergency Preparedness Additional Requirements for Facilities that Care for Adults with Serious Cognitive Impairments

Comments:

Date of Inspection: 03/22 & 03/23/2023 9:15am-2:00pm Type of Inspection: Renewal inspection If you have any questions or email changes, please do not hesitate to contact me at sarah.pearson@dss.virginia.gov. If you need a copy of any of the DSS Model forms or to review any inspection or regulation, you can find the information on the internet: www.dss.virginia.gov. Census 68 Number of records reviewed and interviews conducted- 8 records, 6 interviews. All facility self-reported incidents since the last inspection were reviewed on this date. The Licensing Inspector and the Administrator discussed the risk assessment ratings for the violations for this inspection. Please complete the ?plan of correction? and ?date to be corrected? for each violation cited on the violation notice and returned it to the office. You will need to specify how the deficient practice will be or has been corrected. Your plan of correction must contain: 1) steps to correct the noncompliance with the standard(s), 2) measures to prevent the noncompliance from occurring again; and 3) person(s) responsible for implementing each step and/or monitoring any preventive measure(s). The completed corrective action needs to be in the licensing office by 4/4/2023

Violations:

Standard #:	22VAC40-73-440-G
Description:	Based on resident record review and staff interview, it was determined that the facility failed to update the Uniform Assessment Instrument (UAI) when the resident's condition changed. Evidence: Res A, C and D had changes updated on their Individualized Service Plan (ISP), but not on their UAI.
Plan of Correction:	UAIs for Res A, C and D have been updated. Resident Care Director will audit all resident's charts by April 5, 2023 and update as needed.