VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Renaissance of Annandale
7112 Braddock Road
Annandale, VA 22003
(703) 256-2525

Current Inspector: Marshall Massenberg (804) 543-5188

Inspection Date: June 15, 2022 and June 17, 2022

Complaint Related: No

Areas Reviewed:

Administration and Administrative Services Personnel Staffing and Supervision Admission, Retention and Discharge of Residents Resident Care and Related Services Building and Grounds emergency Preparedness

Comments:

Date of Inspection: June 15 and 17, 2022 Type of Inspection: Monitoring Inspection If you have any questions or email changes, please do not hesitate to contact me at laura.lunceford@dss.virginia.gov. If you need a copy of any of the DSS Model forms or to review any inspection or regulation, you can find the information on the internet: www.dss.virginia.gov. Census 43 Number of records reviewed and interviews conducted- 4 resident records and 4 staff records, 5 interviews. All facility self-reported incidents since the last inspection were reviewed on this date. The Licensing Inspector observed the residents eating lunch and activities. The Licensing Inspector reviewed the following documents during the inspection: fire drills, healthcare oversight, emergency preparedness drills, activity schedule, and dietician report. The Licensing Inspector and the Administrator discussed the risk assessment ratings for the violations for this inspection. Please complete the ?plan of correction? and ?date to be corrected? for each violation cited on the violation notice and returned it to the office. You will need to specify how the deficient practice will be or has been corrected. Your plan of correction must contain: 1) steps to correct the noncompliance with the standard(s), 2) measures to prevent the noncompliance from occurring again; and 3) person(s) responsible for implementing each step and/or monitoring any preventive measure(s).

Violations:

Standard #:	22VAC40-73-450-D
Description:	Based on resident record review and staff interview, it was determined that the facility failed to have on the Individualized Service Plan (ISP) a coordinated plan of care between the facility and the hospice agency. Evidence: resident A had no documentation on the ISP of a coordinated plan of care between the facility and the hospice agency.
Plan of Correction:	All residents receiving hospice services will have documentation of a coordinated plan of care between the facility and the hospice agency. Nursing staff will complete random audits of the records to ensure compliance.
Standard #:	22VAC40-73-450-F
Description:	Based on resident record review and staff interview, it was determined that the facility failed to update the Individualized Service Plan (ISP) to reflect a change in condition of a resident in care. Evidence: Resident B had no documentation on the ISP to reflect the protocol for wound care. Resident C had no documentation of the ISP to reflect the home health services being provided.
Plan of Correction:	All residents ISPs will accurately reflect any change in condition as required. Nursing staff will audit the ISPs to ensure compliance.