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: Oct. 5, 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 Resident Accommodations and Related Provisions Building and Grounds Emergency Preparedness Additional Requirements for Facilities that Care for Adults with Serious Cognitive Impairments

Comments:

Date of Inspection: October 5, 2022, 9:30am-2:32pm Type of Inspection: Renewal inspection If you have any questions or email changes, please do not hesitate to contact me at sarah.pearson@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 47 Number of records reviewed and interviews conducted- 8 records, 5 interviews. All facility self-reported incidents since the last inspection were reviewed on this date. 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). The completed corrective action needs to be in the licensing office by October 12, 2022

Violations:

Standard #:	22VAC40-73-450-C
Description:	Based on resident records review and staff interview, it was determined that the facility to update Individual Service Plan (ISP) for Resident B and C to reflect a change in condition.
Plan of Correction:	All resident's ISPs will include a description of what services will be provided to address identified needs. Nursing staff will audit all ISPs to ensure compliance.