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: April 13, 2022 and April 18, 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 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.

Comments:

An unannounced mandated monitoring study began on 4/13/2022 and concluded on 4/18/2022. At the time of entrance 93 residents were in care. The sample size consisted of nine resident records plus two discharged resident records, five staff records, two volunteer records and two individual interviews. Resident and staff records and other documentation were reviewed. Criminal Background Checks of all staff hired since the previous inspection conducted on 8/13/2020 were reviewed. Residents were observed eating breakfast and lunch and engaging in activities including current events and arts and crafts. Medication administration was observed. Violation notice issued, risk ratings reviewed and exit interview 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 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 #:	22VAC40-73-320-A
Description:	Based upon a review of records, the facility failed to ensure that the resident's physical examination reports contained the following: a statement that the individual does not have any of the conditions or care needs prohibited by 22VAC40-73-310 H, and a statement that specifies whether the individual is considered to be ambulatory or non-ambulatory as defined in this chapter. Evidence: 1. The physician's reports for Residents #1, #2, #3, #5, #6, #7, #8, and #9 did not include a statement that residents did not have the following conditions or care needs: ventilator dependency; dermal ulcers III and IV except those stage II ulcers that are determined by an independent physician to be healing; intravenous therapy or injections directly into the vein, except for intermittent intravenous therapy managed by a health care professional licensed in Virginia or as permitted in Subsection K of this section; psychotropic medications without appropriate diagnosis and treatment plans; nasogastric tubes; and gastric tubes except when the individual is capable of independently feeding himself and caring for the tube or as permitted in subsection K of this section. 2. The physician's reports for Residents #1, #2, #3, #5, #6, #7, #8, and #9 did not document if the residents were ambulatory, defined as the condition of a resident who is physically and mentally capable of self-preservation by evacuating in response to an emergency to a refuge area as defined by 13VAC5-63, the Virginia Uniform Statewide Building Code, without the assistance of another person, or from the structure itself without the assistance of another person if there is no such refuge area within the structure, even if such resident may require the assistance of a wheelchair, walker, cane, prosthetic device, or a single verbal command to evacuate. Nor did the physicians report document if the residents were non-ambulatory, defined as the condition of a resident who by reason of physical or mental impairment is not capable of self-preservation without the assistance of another person.
Plan of Correction:	A current form is in place as part of the Assisted Living moving in packet that outlines the mobility capabilities of an incoming resident. Community will ensure that this section of the form is completed to required standards. Community will implement recommended state form 032-05-007-eng. as part of the move-in packet.
Standard #:	22VAC40-73-650-B
Description:	Based upon a review of resident records, the facility failed to ensure that physician or other prescriber orders, both written and oral, for administration of all prescription and over-the-counter medications and dietary supplements shall include the name of the resident, the date of the order, the name of the drug, route, dosage, strength, how often medication is to be given, and identify the diagnosis, condition, or specific indications for administering each drug. Evidence: A physician's order written on 4/12/2022 for Resident #6, was written as follows: "Medrol dose pack as directed for URI."
Plan of Correction:	Physicians orders will be reviewed by the wellness nurse or Resident Care Manager (RCM) to ensure that all required information is written accurately.
Standard #:	22VAC40-73-660-A
Description:	Based upon observation of medication administration, the facility failed to ensure that a medicine cabinet, container, or compartment shall be used for storage of medications and dietary supplements prescribed for residents when such medications and dietary supplements are administered by the facility. Medications shall be stored in a manner consistent with current standards of practice. Evidence: During medication administration observation at approximately 9:30 am on 4/13/2022, LI observed one pharmacy container (bubble packet) containing medication lying on top of a medication cart. The medication cart was located in the safe and secure unit.
Plan of Correction:	In-service all med techs on proper storage of medications.
Standard #:	22VAC40-73-680-D
Description:	Based upon a review of records and observation of packaged medication, the facility failed to ensure that medications shall be administered in accordance with the physician's or other prescriber's instructions and consistent with the standards of practice outlined in the current registered medication aide curriculum approved by the Virginia Board of Nursing. Evidence: Resident #6 had a physician's order to receive Methylprednisolone 4mg Dosepk as follows: Day 1 (which was 4/13/2022): two tablets before breakfast, one tablet after lunch, one tablet after dinner, and two tablets at bedtime. The April 2022 Medication Administration Record (MAR) documents that on 4/13/2022, Resident #6 was administered the medication as prescribed. On 4/14/2022, LI looked at the pharmacy container (bubble packet) for the Methylprednisolone 4mg Dosepk and observed one of the two tablets still in the bubble packet for the bedtime dosage of Day 1 (4/13/2022).
Plan of Correction:	The community's contracted pharmacy will create separate entries on the e-mar for each dose of titrated medication.