VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Vienna Manor III, LLC
10137 Palmer Drive
Oakton, VA 22124
(703) 938-2715

Current Inspector: Alexandra Roberts

Inspection Date: Jan. 28, 2022

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.

Comments:

An unannounced monitoring inspection was conducted on 1/28/22. At the time of entrance, eight residents were in care. An activity was observed 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. Areas of non-compliance are identified on the violation notice. Please complete the 'plan of correction' and 'date to be corrected' for each violation cited on the violation notice and return to the licensing office within 10 calendar days. Please specify how the deficient practice will be or has been corrected. Just writing the word 'corrected' is not acceptable. The 'plan of correction' must contain: 1) Steps to correct the non-compliance with the standards, 2) Measures to prevent the non-compliance from occurring again, and 3) Person responsible for implementing each step and/or monitoring any preventative measures. Thank you for your cooperation and if you have any questions, please contact me via e-mail at m.massenberg@dss.virginia.gov.

Violations:

Standard #:	22VAC40-73-490-D
Description:	Based on record review, the facility failed to ensure that a written health care oversight, completed at least every three months, is maintained in the facility files. Evidence: The most recent health care oversight was requested, during the inspection. The facility record included a health care oversight that was dated 5/1/21. This oversight was more than three months old, at the time of the inspection.
Plan of Correction:	Vienna Manor employs a full time nurse to provide oversight on the healthcare needs of our residents. VM Nurse was able to provide an extra copy of the most recent health care oversight, dated 2/1/22, to the inspector at the time of the inspection. Vienna Manor will keep an extra electronic copy of health care oversight for better record keeping.
Standard #:	22VAC40-73-680-M
Description:	Based on observation and interview, the facility failed to ensure that medications ordered for PRN administration are available and properly stored at the facility. Evidence: PRN Ondansetron, ordered 12/30/20 for Resident #1, was not available for administration. Resident #1 had Ondansetron tablets at the facility, but they expired in November 2021. Facility staff reported that Resident #1 did not have any additional Ondansetron tablets at the facility, that were not expired.
Plan of Correction:	Ondansetron tab as needed for Resident #1 was discontinued by her physician on 1/28/2022 at the time of the inspection. Resident #1 does not need Ondansetron tab per her physician. Pharmacy will inform Vienna Manor if the medication will need refills ahead of time so we can notify their Physician to order a refill.