VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Harmony at Spring Hill
8350 Mountain Larkspur Drive
Fairfax, VA 22079
(571) 348-4970

Current Inspector: Amanda Velasco (703) 397-4587

Inspection Date: June 7, 2024

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 STAFFING AND SUPERVISION 22VAC40-73 ADMISSION, RETENTION AND DISCHARGE OF RESIDENTS 22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-73 RESIDENT ACCOMMODATIONS AND RELATED PROVISIONS 22VAC40-73 BUILDINGS AND GROUND

Technical Assistance:

N/A

Comments:

Type of inspection: Complaint Date of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 06/07/2024: 10:45 AM to 12:45 PM The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. A complaint was received by VDSS Division of Licensing on 06/03/2024 regarding allegations in the areas of: Resident Care and Related Services and Staffing and Supervision. Number of resident records reviewed: 1 Number of staff records reviewed: 0 Number of interviews conducted with residents: 1 Number of interviews conducted with staff: 6 Additional Comments/Discussion: N/A An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation supported some, but not all of the allegations; area(s) of non-compliance with standard(s) or law were: Resident Care and Related Services, Resident Accommodations and Services, and Buildings and Ground. A violation notice was issued; any violation(s) not related to the complaint 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 Amanda Velasco, Licensing Inspector at (703) 397 4587 or by email at Amanda.Velasco@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-280-A
Complaint related:	Yes
Description:	Based on resident record review, collateral contact interview and staff interview, the facility failed to ensure that staff were sufficient in numbers to provide services to attain and maintain the physical, mental, and psychosocial well-being of each resident as determined by resident assessments and individualized service plans. Evidence: 1. Resident 1?s UAI, dated 03/12/2024, assesses the resident as needing mechanical and physical assistance with bathing, dressing, toileting, and transferring. The UAI noted that Resident 1 requires physical assistance with wheeling and mechanical help and physical assistance for mobility. 2. Resident 1?s progress notes documented that EMS/911 was called to help the resident after a fall or with transferring on the following dates: a. On 6/01/24 at 2:23 AM, the progress notes state ?05/31/2024 At 11pm?Two staff members tried getting her off the floor but was unsuccessful due to dead weight of resident. 911 was called to help lift the resident back into [Resident 1?s] wheelchair.? This note was written by Staff 3. b. There is an additional note written by Staff 3 at 3:24 AM on 06/01/2024 that states ?11:15 PM?. Staff tried to pick [Resident 1] up, [Resident 1] could not help. Resident called 911 for help lifting [Resident 1]. 2 men held upper body and 2 on lower body. Resident was put in [Resident 1?s] w/c.? c. On 4/26/2024, a progress note was entered that states ?staff were not able to lift resident up from the floor and called 911 to pick her up from the floor.? 3. During a phone interview conducted by LI on 06/07/2024, Staff 4 confirmed that EMS/911 was frequently called due to the dead weight of the resident when intoxicated and two (2) staff not being enough to lift/transfer resident. Staff 4 asked what they are supposed to do when ?... [Resident 1] gets obliterated, and we can?t pick [Resident 1] up?? 4. A progress note written on 6/1/2024 at 2:23 AM by Staff 3 ?Resident on several occasions has called for help the caregiver were there to help her all the time, at 4:00 AM resident called for 911 without my knowledge of EMS agent was already in the building. Resident told EMS agent [Resident 1] wants to go to the bathroom that made her call for help.? 5. The incident documented on 06/01/2024 by Staff 3 was verified by Collateral Contact 1 in a phone interview with the LI on 7/8/2024. Collateral Contact 1 shared they could not find staff to assist them in entering the building or locating and providing care to Resident 1. Collateral Contact 1 remained in the Room of Resident 1 to provide care and sent their team to find facility staff, twice, before the team reported to Collateral Contact 1 that they had located three staff in a closet asleep. The team returned to the room with Staff 6 and another staff that Collateral Contact 1 could not identify. 6. In an interview with the LI on 06/07/2024, Resident 1 stated that they don?t have many staff at night. Resident 1 was concerned about being labeled as a ?complainer? but stated ?I?m so embarrassed? when having to wait an extended amount of time with incontinence care.
Plan of Correction:	Community has adjusted number of direct team on duty in the neighborhood, additional training was provided to the team, including understanding when to call for Emergency services.
Standard #:	22VAC40-73-280-B
Complaint related:	No
Description:	Based on facility document review, the facility failed to maintain a written plan that specifies the number and type of direct care staff required to meet the day to day, routine direct care needs and any identified special needs for the residents in care. Evidence: 1. A copy of the written staffing plan was requested to Staff 1 by the LI on 06/07/2024. 2. The facility?s Policy and Procedure; Policy Title: Staffing 22 VAC 40-73-280; date implemented and revised 02/2018 was provided to the LI via email from Staff 7 on 06/27/2024, and states ?Harmony Senior Services will provide a sufficient number of team members with Adequate knowledge and skills to attain and maintain the physical, mental and psychosocial well-being of each resident as outlined in their individualized service plan.? 3. The written staffing plan does not specify the number and type of direct care staff needed to meet the day to day, routine direct care needs and any identified special needs for the residents in care.
Plan of Correction:	Resident resides in Assisted Living neighborhood. Community has adjusted the number of direct staff to meet the daily needs of residents in the neighborhood
Standard #:	22VAC40-73-310-A
Complaint related:	Yes
Description:	Based on resident record review and staff interview the facility failed to ensure that no resident was retained for whom the facility cannot secure or provide the appropriate care or if the facility does not have staff appropriate in numbers and with appropriate skill to provide the care and services needed by the resident. 1. Resident 1?s individualized service plan, effect 03/12/2024, listed Resident 1?s diagnosis as Alcohol Abuse, Chronic Obstructive Pulmonary Disease (COPD), Dementia, Depression, Diabetes mellitus, Hypertension (HTN), and Acute Kidney Failure under clinical information. 2. Resident 1 had falls on the following date that were attributed to alcohol use per Staff 6 and Staff 3 in the progress notes. a. 06/01/2024 ? Progress notes by Staff 3 state ?11:15 PM screams for help coming from resident?s room?A red plastic glass with liquid was seen next to her. [Resident 1] said its apple juice. Writer saw a large clear plastic pouch, unlabeled, what appears to be wine in the bathroom next to [Resident 1]? b. 05/31/2024 ? Progress notes by Staff 6 state ?When EMS left the way Res was behave, we made a searching [Resident 1] room we discovered a big bottle of wine under Res sink in [Resident 1] room while there was a little served wine plastic cup. 3. Resident 1 had a fall on 05/13/2024.Staff 6 writes the following in a progress note: a. ?Resident was found on the bathroom floor at 12 :20am as the caregiver was doing her rounds. Resident was screaming about her back pain 911 was called in and resident refused to go to the hospital.? 4. On 06/05/2024, Staff 10 wrote the following on the progress notes: a. ?Writer found that the resident leg was swollen. Resident said [Resident 1] had a pain and put ice pack on [Resident 1?s] leg. Writer asked the resident to go to hospital for further evaluation for it, but [Resident 1] denied going to the hospital.? 5. Staff 2 and 5 confirmed with the LI on 06/07/2024 that they were unsure how to help the resident due to the refusal of care and alcohol usage.
Plan of Correction:	New leadership team met with resident and husband. Resident? needs were identified and plan of care was updated. Overall changes noted in resident? care were triggered by resident `s alcohol abuse. Possible discharge of resident was discussed with resident and husband, the community team has been involved and supportive of resident?s care, alcohol intake has decreased, room has been checked several times, wine containers found in room were removed and taken away by husband, resident has agreed to cooperate and has been more involved in activities offered in the community. No more falls noted, resident is making progress, and husband has been more involved in resident's care.
Standard #:	22VAC40-73-450-F
Complaint related:	Yes
Description:	Based on resident record review, the facility failed to ensure the that each individualized service plan (ISP) was reviewed and updated at least once every 12 months and as needed for a significant change of a resident?s condition. Evidence: 1. Resident 1?s, admitted 04/03/2023, ISP was completed on 03/12/2024. 2. Resident 1?s ISP states ?Frequent mood and depression issues. Resident has current or history of frequent depression or mood disorder. Anytime during shift as needed.? 3. Resident 1?s ISP states ?Minimal substance use issues. Resident has current or history of substance use which may cause some interpersonal and/or health problems, but does not significantly impair overall independent functioning. May have behavior management plan in place. Anytime during shift as needed.? 4. Resident 1?s ISP states ?Fall Potential: HIGH. Resident is at a high potential for falls. PERSONALIZE interventions? under the category of ?Fall Potential.? 5. The intervention or expected service from direct care for the focuses of mood and depression issues, substance use issues, and fall potential is not clearly stated in the ISP.
Plan of Correction:	New leadership team met with resident and husband. Resident? needs were identified and plan of care was updated. Overall changes noted in resident? care were triggered by resident `s alcohol abuse. The community team has been involved and supportive of resident?s care, alcohol intake has decreased, room has been checked several times, wine containers found in room were removed and taken away by husband, resident has agreed to cooperate and has been more involved in activities offered in the community. No more falls noted, resident is making progress, and husband has been more involved in resident's care.
Standard #:	22VAC40-73-460-D
Complaint related:	Yes
Description:	Based on resident record review and staff interview, the facility failed to provide supervision of resident schedules, care, and activities, including attention to specialized needs. Evidence: 1. In a phone interview with Collateral Contact 1 on 07/08/2024, Collateral Contact 1 stated that EMS was called to the facility on the night of 05/31/2024 by Resident 1. Collateral Contact 1 stated Resident 1 was stuck in the lazy boy recliner. Collateral Contact 1 stated that EMS arrived on site between 2 AM and 4 AM and was unable to enter the locked doors on site. Collateral Contact 1 stated that the first set of sliding doors does not lock, and the second set of sliding doors was pried apart manually. Collateral Contact 1 was unable to locate staff and proceeded to head to Resident 1?s room to assist the resident. Resident 1 told Collateral Contact 1 that they had been pushing the pendent and calling staff of the facility on the phone and was not receiving a response. Collateral Contact 1 was told by Staff 6 that they did not receive any calls. Collateral Contact 1 saw Staff 6 pull out a phone that displayed multiple missed calls and voicemails. 2. During the onsite inspection conducted on 06/07/2024, Staff 1 confirmed the recliner leg rest became stuck, and Resident 1 was unable to get out of the recliner independently. Staff 1 stated that the legal representative was aware and planned to get the recliner fixed. 3. In a phone interview with the LI conducted with Staff 6 on 07/25/2024, Staff 6 stated that Resident 1 was frequently calling staff for assistance through the call bell that evening and was unsure why Resident 1 called 911. Staff 6 stated that on the night of 05/31/2024, they were completing medication audits when they were notified by Staff 8 that EMS was in the building. 4. The pendent report log shows two calls made by Resident 1 on 05/31/2024 at 1:32 AM, answered in 3 minutes and 44 seconds, and 1:49 AM, answered in 1 min and 31 seconds. 5. Staff 6 documented in a progress note on 06/01/2024 at 2:36 AM ?Resident on several occasion has has called for help the caregiver were there to help her all the time, at 4 am resident called for 911 without my knowledge of EMS agent was already there in the building. Resident told EMS agent [Resident 1] wanted to go to the bathroom that made her called for help. When the caregiver was dressing the resident was dressing the resident EMS agents advised us to always be kind with residents.?
Plan of Correction:	Resident was reassessed on 8/11/24, plan of care was updated, resident?s husband is involved and very supportive of resident?s care and overall well-being. A new pendant was given to resident, care team will continue to check on resident frequently and assist resident as needed.
Standard #:	22VAC40-73-460-E
Complaint related:	Yes
Description:	Based on resident record review and staff interview, the facility failed to regularly observe each resident for changes in physical, mental, emotional, and social functioning and document changes and any corresponding in the resident's record. Evidence: 1. In an interview with the LI on 06/07/2024, Staff 3 stated that they were concerned about Resident 1?s alcohol usage. They advised Resident 1?s husband to take away the alcohol in Resident 1?s room, as well as take away the cards used to purchase the alcohol. 2. In a phone interview with the LI conducted on 7/25/2024, Staff 6 stated that the resident was frequently drinking in the room. 3. Resident 1?s record contains progress notes written on 5/03/2023 stated ?Upon admission residents? PCP checked that [Resident] should not be served alcohol. On this day staff found in resident?s room, alcohol bottles in the trash and multiple bottles in the fridge. This writer called Husband to notify. Husband stated he will be taking away [Resident 1?s] cards and take alcohol.? This information, the admission document checked by the PCP, was unable to be located on the date of the inspection. 4. Resident 1?s progress notes written on 06/20/2023 stated ?staff witnessed resident with a glass of wine. Resident has an order not to consume alcohol. Resident has been voiding frequently and not wanting to be changed. This writer called the Husband, [Husband?s Name]. Husband stated that he will be on the way to remove the remaining alcohol and to take [Resident 1?s] debit card and phone away. Resident is using [Resident 1?s] phone to make mobile grocery orders.? This order was unable to be located by facility staff on the day of inspection. 5. Staff 2 and 5 confirmed during the preliminary exit interview on 06/07/2024 that they were unaware of this order and have allowed Resident 1 to consume alcohol at activities and have not been removing alcohol from the Resident?s room. 6. Resident 1?s Psych Progress Note, dated 05/08/2024, stated that the resident had ?daily alcohol intake per staff? and the resident expressed she was ?feeling highly anxious about her health and substance use triggers.? The Psych Progress Note states ?patient is encouraged to participate in activities on the unit, Psychiatric team will monitor mood and behavior follow up weekly till patients stable then biweekly." 7. No other psych visits were documented in the resident?s record or provided to the LI.
Plan of Correction:	New leadership team met with resident and husband. Resident? needs were identified and plan of care was updated. Overall changes noted in resident? care were triggered by resident `s alcohol abuse. The community team has been involved and supportive of resident?s care, alcohol intake has decreased, room has been checked several times, wine containers found in room were removed and taken away by husband, resident has agreed to cooperate and has been more involved in activities offered in the community. No more falls noted, resident is making progress, and husband has been more involved in her care.
Standard #:	22VAC40-73-870-B
Complaint related:	No
Description:	Based on direct observation, the facility failed to ensure that all buildings shall be well-ventilated and free from foul, stale, and musty orders. Evidence: 1. During the onsite inspection on 006/07/2024, a smell of urine was noticed upon exiting the elevator on floor 2. 2. In Resident 1?s room, the smell of urine was stronger, and a half full trash bag was observed by the door. 3. The recliner in the room of Resident 1 had a pad that had pilling of the material and discoloration. 4. The carpet in the room of Resident 1 had staining near the bathroom door. 5. Photo evidence taken.
Plan of Correction:	Resident?s room was not well kept due to resident's inability to keep resident's room clean and due to several uncontrolled bladder and bowel accidents after alcohol use. Resident?s room has been frequently checked and cleaned. Less accidents noted, resident is involved and resident is currently participating in the effort of keeping resident's room clean and free from odors.