VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Harmony at Chantilly
2980 Centreville Road
Herndon, VA 20171
(703) 994-4561

Current Inspector: Amanda Velasco (703) 397-4587

Inspection Date: April 16, 2024

Complaint Related: No

Areas Reviewed:

22VAC40-73 GENERAL PROVISIONS 22VAC40-73 STAFFING AND SUPERVISION 22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-73 RESIDENT ACCOMMODATIONS AND RELATED PROVISIONS 22VAC40-73 EMERGENCY PREPAREDNESS

Technical Assistance:

Inspector reviewed file retention policies for resident records.

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: Tuesday, April 16, 2024, from 12:40 PM to 2:00 PM. 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: 41 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. The licensing inspector observed residents during down time and meals. The licensing inspector reviewed the following at the time of inspection: resident files, emergency procedures, and the call-bell/rounding policies. Number of resident records reviewed: 1 Number of staff records reviewed: 0 Number of interviews conducted with residents: 0 Number of interviews conducted with staff: 1 An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation did not support the self-report of non-compliance with standard(s) or law. However, violation(s) not related to the self-report but identified during the course of the investigation can 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 Amanda Velasco, Licensing Inspector at (703) 397- 4587 or by email at Amanda.Velasco@dss.virginia.gov.

Violations:

Standard #:	22VAC40-73-680-E
Description:	Based on resident record review and staff interviews, the facility failed to ensure that treatments ordered by a physician were provided according to his instructions and documented. Evidence: 1. Resident 1?s physician order dated 11/17/2020 stated, ?check vital signs daily and fax to NP?. 2.Resident 1?s Treatment Administration Record for the months of March and April 2024, contained documentation that the resident was weighed once a month on March 13, 2024 and April 07th, 2024. All other dates, the weight column had ?0? or ?00? listed with no further documentation. 3. Resident 1?s record did not contain documentation that the vital signs that were taken were faxed to the Nurse Practitioner. 4. Staff 1 confirmed the resident weights were not taken according to physician orders.
Plan of Correction:	An 100% audit of physician orders will be conducted to ensure all treatment orders are being followed and documented as the prescriber has prescribed. A monthly review of treatment administration records will be conducted by the Health Care Director to ensure compliance in accordance with standard 22VAC40-73-680.E. The plan of correction will be fully implemented, and noncompliance promptly corrected by May 31, 2024.