VIRGINIA DEPARTMENT OF SOCIAL SERVICES

The Virginian
9229 Arlington Boulevard
Fairfax, VA 22031
(703) 385-0555

Current Inspector: Amanda Velasco (703) 397-4587

Inspection Date: Oct. 3, 2019 and Oct. 4, 2019

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 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 renewal inspection was conducted on 10/3/19 and 10/4/19. At the time of entrance, 174 residents were in care. Meals, medication administration, and activities were observed. Building and grounds were inspected and records were reviewed. The sample size consisted of 10 resident records and five staff records. Violations were discussed and an exit meeting was 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 standards, 2) Measures to prevent the non-compliance from occurring again, and 3) Person responsible for implementing each step and/or monitoring any preventative measures. Thank you for your cooperation and if you have any questions, please contact me via e-mail at m.massenberg@dss.virginia.gov.

Violations:

Standard #:	22VAC40-73-450-C
Description:	Based on record review, the facility failed to ensure that the individualized service plan (ISP) is based upon the uniform assessment instrument (UAI) and other sources. Evidence: The UAI for Resident #1, dated 6/17/19, states that the resident needs only mechanical assistance for dressing. The ISP for Resident #1, dated 6/23/19, calls for a walker and standby assistance for dressing. The record for Resident #2 includes a signed DNR order, dated 3/29/19. The ISP for Resident #2, dated 10/9/18, did not address the resident's DNR order. The ISP lists the resident as full code. The UAI for Resident #6, dated 8/13/19, states that the resident needs no assistance for dressing. The ISP for Resident #6, dated 8/19/19, states that the resident needs assistance with dressing sometimes. The UAI for Resident #9, dated 6/5/19, states that the resident needs no assistance for dressing. The ISP for Resident #9, dated 8/7/19, calls for staff to lay clothes out and cueing as needed for dressing.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-680-M
Description:	Based on observation, the facility failed to ensure that medications ordered for PRN administration are available, properly labeled for the specific resident, and properly stored at the facility. Evidence: Resident #3's PRN Acetaminophen was expired at the time of the medication cart inspection. The expiration date on the bottle was 2/21/19.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-970-A
Description:	Based on documentation, the facility failed to ensure that fire and emergency evacuation drill frequency and participation are conducted in accordance with the current edition of the Virginia Statewide Fire Prevention Code (13VAC5-51). The drills required for each shift in a quarter shall not be conducted in the same month. Evidence: The Virginia Statewide Fire Prevention Code calls for ALFs to complete fire drills quarterly on each shift. The facility has three shifts. There were no fire drills that were documented as being completed in the month of September. No fire drills were conducted during the evening or overnight shifts, within the past three months.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-90-40-B
Description:	Based on documentation and interview, the facility failed to obtain a criminal history record report, from the Department of State Police, within 30 days of hiring an employee. Evidence: The records of new staff members (#s 6 - 24) contained national criminal record checks that were provided by a private company. The records of the employees, hired from May 2019 until September 2019, did not contain a criminal history record report from the Department of State Police, by the 30th day of employment for each employee. Facility staff confirmed that the new staff members received a national criminal record check, instead of the criminal history record report from the Department of State Police.
Plan of Correction:	Not available online. Contact Inspector for more information.