VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Waltonwood Ashburn
44145 Russell Branch Parkway
Ashburn, VA 20147
(571) 918-4854

Current Inspector: Amanda Velasco (703) 397-4587

Inspection Date: July 24, 2019

Complaint Related: No

Areas Reviewed:

22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS Article 1 Subjectivity

Comments:

On 7/24/19 Licensing Inspector (LI) conducted unannounced focused monitoring visit to ensure correction of violations cited during 5/17/19 focused study of a self-reported incident. Reviewed resident records and pharmacy delivery documentation. All previous violations were found to have been corrected. LI also conducted unannounced inspection in response to a self-reported incident. Reviewed resident records and other documentation, toured the physical plant, and interviewed staff. Possible violations were reviewed at the exit interview. 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 standard(s), 2) measures to prevent the non-compliance from occurring again; and 3) person(s) responsible for implementing each step and/or monitoring any preventative measure(s). Thank you for your cooperation and if you have any questions please call 703-479-5247 or contact me via e-mail at jamie.eddy@dss.virginia.gov.

Violations:

Standard #:	22VAC40-73-1150-A
Description:	Based upon interviews and review of resident records and other documentation, the facility failed to ensure that doors that lead to unprotected areas shall be monitored or secured through devices that conform to applicable building and fire codes, including but not limited to, door alarms, cameras, constant staff oversight, security bracelets that are part of an alarm system, pressure pads at doorways, delayed egress mechanisms, locking devices, or perimeter fence gates. Residents who reside in safe, secure environments may be prohibited from exiting the facility or the special care unit, if applicable building and fire codes are met. Evidence: On June 24, 2019, Resident #1 was able to exit the secured care unit to an unprotected area outside of the facility when an egress door malfunctioned.
Plan of Correction:	A. Doors that lead to unprotected areas shall be monitored or secured through devices that conform to applicable building and fire codes, including door alarms, cameras, constant staff oversight, security bracelets that are part of an alarm system, pressure pads at doorways, delayed egress mechanisms, locking devices, or perimeter fence gates. Residents who reside in safe, secure environments may be prohibited from exiting the facility or the special care unit if applicable building and fire codes are met. Resident #1 was able to exit the secured care unit into an unprotected area outside the facility when an egress door malfunctioned. Corrective Action(s): 1. Door was monitored 24 hours a day until door was fixed. 2. Door was fixed on 7/12/19 and secured. Preventative Measures to mitigate non-compliance: 1. Community will install audible battery power door alarm to notify staff when door is ajar. 2. Community will verify exit door is working properly twice daily until audible alarm is installed. 3. Community will monitor exit door on a daily basis after audible alarm is installed. Responsible parties: ? Executive Director: Justin Roberts ? Wellness Coordinators: Yesenia Villalbaso and Mary Franck-Rolin, LPN ? Environmental Services Manager ? Supervisor in Charge