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: Dec. 5, 2019

Complaint Related: No

Areas Reviewed:

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

Comments:

On 12/5/19 Licensing Inspector (LI) conducted unannounced inspection in response to self-reported incidents. LI reviewed seven resident records and conducted staff interviews. LI also inspected the physical plant. A review of possible violations were discussed at the exit interview.

Violations:

Standard #:	22VAC40-73-1100-B
Description:	Based upon a review of records, the facility failed to ensure that the obtained written approval shall be retained in the resident's file. Evidence: The file for Resident #1 did not contain written approval for placement in the special care unit.
Plan of Correction:	Resident #1--Obtain written approval for placement in a special care unit (12/13/19). Complete an internal file audit to ensure all other special care unit residents have the required written approval for placement (12/13/19). Responsible parties: Chris Leinauer (Executive Director); Maria Manalo (Resident Care Manager); and Megan Mastre (Wellness Coordinator).
Standard #:	22VAC40-73-930-D
Description:	Based upon a review of records and interviews with staff, the facility failed to ensure that for each resident with an inability to use the signaling device, in addition to any other services, the following shall be met: this inability shall be included in the resident's individualized service plan. Evidence: Residents #1, #2, #3, and #4 do not have the ability use the signaling device. This inability was not included on the Individualized Service Plans (ISPs) for Residents #1, #2, #3, and #4.
Plan of Correction:	Document in the individual service plan for Resident #1, #2, #3, and #4, their inability to use a signaling device (12/13/19). Complete an internal audit to ensure all other residents with the inability to use a signaling device have the required documentation (12/13/19). Responsible parties: Chris Leinauer (Executive Director); Maria Manalo (Resident Care Manager); and Megan Mastre (Wellness Coordinator).