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: Sept. 11, 2024

Complaint Related: No

Areas Reviewed:

Administration and Administrative Services Resident Care and Related Services

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: 9/11/2024 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: 73 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 1 Number of staff records reviewed: N/A Number of interviews conducted with residents: N/A Number of interviews conducted with staff: 1 Observations by licensing inspector: N/A Additional Comments/Discussion: An exit meeting will be conducted to review the inspection findings. Supported. The evidence gathered during the investigation supported the self-report of non-compliance with standard(s) or law, and violation(s) were issued. Any violation(s) not related to the (complaint(s)/self-report) but identified during the course of the investigation can also be found on the violation notice. 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 #:	22VAC40-73-460-A
Description:	Based on resident record review and staff interview, the facility failed to assume general responsibility for the health, safety, and well-being of the residents. Evidence: 1. Resident 1 had an Assessment of Serious Cognitive Impairment completed on 8/27/2024 by a physician who indicated the resident having the inability to recognize danger and protect his own safety and welfare. 2. Uniform Assessment instrument completed on 9/5/2024 assessed Resident 1?s Behavior Pattern as Wandering/Passive ? Weekly or more, and Orientation as Disoriented ? all spheres, some of the time. 3. Staff 1 said Resident 1 was let out of the secured unit by a visitor that had the access code on 9/9/2024 and left the facility undetected.
Plan of Correction:	? The entrance and exit door code was changed immediately for Memory Care. The families and visitors will only be let in and out accompanied by the community staff. ? This resident is now also wearing a wander guard so if she somehow leaves Memory Care the other doors will alarm if she is near the exit. ? We have residents? picture at the front desk so the team at the front desk can keep close eyes who is existing the building.