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. 18, 2023

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 ACCOMMODATIONS AND RELATED PROVISIONS 22VAC40-73 BUILDINGS AND GROUND 22VAC40-73 EMERGENCY PREPAREDNESS 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS 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

Technical Assistance:

Documentation was discussed with the provider.

Comments:

Type of Inspection: Renewal Date of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 9/18/23 (9:40 AM ? 6:00 PM). The acknowledgement of inspection form was signed and left at the facility for each date of the inspection. Number of residents present at the facility at the beginning of the inspection: 97 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: six Number of interviews conducted with residents: four Number of interviews conducted with staff: two Observations by licensing inspector: Medication administration, meals, activities An exit meeting was held. The evidence gathered during the inspection determined non-compliance with applicable standard(s) or law, and violation(s) were documented on the violation notice issued to the facility. 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. For more information about the VDSS Licensing Programs, please visit: www.dss.virginia.gov Should you have any questions, please contact Marshall Massenberg, Licensing Inspector at (703) 431-4247 or by email at m.massenberg@dss.virginia.gov.

Violations:

Standard #:	22VAC40-73-250-C
Description:	Based on documentation, the facility failed to ensure that all of the required information is included in the staff record. Evidence: The record for Staff #3 (hired 8/1/23) was reviewed during the inspection. Staff #3's record did not contain documentation of her orientation, at the time of the inspection. No documentation was provided, during the inspection, to indicate that Staff #3 had completed a facility orientation.
Plan of Correction:	We will conduct an audit of all employee records to ensure compliance with 22VAC40-73-250-C. We will increase the frequency of New Employee Orientation to ensure we're capturing all new employees.
Standard #:	22VAC40-73-640-A
Description:	Based on documentation, the facility failed to implement the medication management plan: to ensure that each resident's prescription medications and any over-the-counter drugs and supplements ordered for the resident are filled and refilled in a timely manner to avoid missed dosages. Evidence: Resident #7's Medication Administration Record (MAR) was reviewed during the inspection. Resident #7's MAR stated that he had missed administrations of his Carbidopa-Levodopa on 9/6/23, as the medication was listed as "awaiting pharmacy delivery." Resident #7's MAR also states that he had missed administrations of his Sertraline on 9/6/23 and 9/7/23, as the medication was listed as "awaiting pharmacy delivery."
Plan of Correction:	Med tech refresher course to be offered by Express Care Pharmacy to include a process for ordering and reordering medications.