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: Sept. 24, 2019 and Sept. 25, 2019

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 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS Article 1 Subjectivity 32.1 Reported by persons other than physicians 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 renewal study was conducted on 9/24/19 and 9/25/19. At the time of entrance 55 residents were in care. The sample size consisted of eight resident records, four staff records, two volunteer records and three individual interviews. Resident and staff records and other documentation were reviewed. Criminal Background Checks of all staff hired since the previous renewal inspection conducted on 10/11/18 were reviewed. Residents were observed eating breakfast and lunch and engaging in activities including Everyday Life Trivia and Senior Olympics-Golf. Medication administration was observed. Possible violations were discussed 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 #:	22VAC40-73-720-A
Description:	Based upon a review of records, the facility failed to ensure that Do Not Resuscitate (DNR) Orders for withholding cardiopulmonary resuscitation from a resident in the event of cardiac or respiratory arrest may only be carried out in a licensed assisted living facility when: the written order is included in the individualized service plan. Evidence: The Individualized Service Plans (ISP) for Residents #2, #3, and #4 did not include their DNR orders.
Plan of Correction:	The care plans for Residents #2, #3, and #4 were updated on 9/26/19 indicating the correct DNR orders.A full audit of all residents was completed on 9/26/19 to ensure all DNR code status were accurately reflected on the individual service plan (ISP). The care plan will be reviewed by the Resident Care Manager, Wellness Coordinator, and the Executive Director. The care plan will be signed off after the code status is reviewed. The responsible parties are: Resident Care Manager, Wellness Coordinator, and Executive Director.
Standard #:	22VAC40-73-870-I
Description:	Based upon physical observation of the building, the facility failed to ensure that elevators, where used, shall be inspected at least annually. Elevators shall be inspected in accordance with the Virginia Uniform Statewide Building Code (13VAC5-63). The signed and dated certificate of inspection issued by the local authority shall be evidence of such inspection. Evidence: According to the certificate of inspection found in the elevators, the certification expired 2/28/19 and a new inspection is due.
Plan of Correction:	The community is scheduled to have the inspection with a 3rd party provider and regulatory official on 10/24/19. Reminders will be set for the Environmental Services Manager and Regional Manager one month prior to the expiration in 2020. This is to alleviate the challenges of scheduling with the 3rd party provider and the inspector. Responsible parties are Environmental Services Manager, Executive Director, and Regional Manager.
Standard #:	22VAC40-90-40-B
Description:	Based upon a review of records, the facility failed to ensure that the criminal history record report shall be obtained on or prior to the 30th day of employment for each employee. Evidence: Eight staff records for staff hired since 10/11/18 had a criminal history record report that was obtained after the 30th day of employment.
Plan of Correction:	An audit of all staff was completed on 9/29/19 and any additional findings were addressed per regulation. On 9/27/19 the organization instituted a new associate file checklist to mitigate concerns which contains the criminal background check documentation. Before new associates files are filed away, the Business Office Manager will ensure all checklists items are completed. Responsible parties are the Business Office Manager and the Executive Director.