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: April 4, 2024

Complaint Related: No

Areas Reviewed:

Administration and Administrative Services 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 Cognitive Impairments Background Checks for Assisted Living Facilities Sworn Statement

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: 04/04/2024 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: 64 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 5 Number of staff records reviewed: 5 Number of interviews conducted with residents: 2 Number of interviews conducted with staff: 4 Observations by licensing inspector: Toured the facility, observed medication administration, checked medication cart for prescribed medications. LI also observed residents participating in activity programs and eating lunch. Additional Comments/Discussion: 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 , Sarah Pearson, Licensing Inspector at (540) 680-9469 or by email at sarah.pearson@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-680-M
Description:	Based on resident record review, staff interview and medication cart audit, the facility failed to have available prescribed PRN medications. Evidence: 1. Resident B had a prescription dated 07/09/2022 for Bisacodyl 10 mg suppository, insert 1 unwrapped suppository into rectum every day as needed for no bowel movement in 3 days, a prescription dated 09/05/2023 for Famotidine 20 mg tablet, may take an additional tablet by mouth as needed for indigestion, a prescription for Preparation H Max Cream, apply to rectal area after each loose stool as needed for hemorrhoid. 2. During medication cart audit with Staff F on 04/04/2024, Staff F could not locate Bisacodyl 10 mg suppository, Famotidine 20 mg tablet or Preparation H Max Cream. Staff F stated ?we do not have those.?
Plan of Correction:	All med/tech and LPNs were educated on the use of all PRN meds and to make sure they are on the cart for use and to be communicated to MD for discontinuation if not used for the last 90 days. Medication cart is audited every Friday by med/tech followed by RCD checking twice per month.