VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Hunters Woods at Trails Edge
2222 Colts Neck Road
Reston, VA 20191
(703) 429-1130

Current Inspector: Jacquelyn Kabiri (703) 397-3017

Inspection Date: June 30, 2021

Complaint Related: No

Areas Reviewed:

22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES 22VAC40-73 RESIDENT CARE AND RELATED SERVICES

Comments:

On 06/30/2021 Licensing Inspector (LI) conducted unannounced inspection in response to self-reported incident. Reviewed resident records and other documentation. Conducted resident and staff interviews. Exit interview conducted with the Executive Director. Violation notice issued and assessed risk assigned to violation. 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, 3) person(s) responsible for implementing each step and/or monitoring any preventative measure(s), and 4) date that that plan of correction will be completed. Thank you for your cooperation and if you have any questions please call (703) 895-5627 or contact me via e-mail at jeannette.zaykowski@dss.virginia.gov.

Violations:

Standard #:	22VAC40-73-460-D
Description:	Based on record review, documentation and interview, facility failed to ensure that the facility shall provide supervision of resident schedules, care, and activities, including attention to specialized needs, such as the prevention of wandering from the premises. EVIDENCE: 1. The facility's incident report dated 05/16/2021 and resident caregiver notes dated 05/15/2021 and 05/17/2021 document that on 05/15/2021 at 4:20 p.m. Resident 1's Private Duty Aid notified staff that Resident 1 could not be found, premises and surrounding areas were searched, police and family were notified for assistance. Documentation shows that Resident 1 was returned to the facility in a private car driven by his previous neighbor who had seen Resident 1 on the deck of his home. 2. Tracking devices were reviewed and video showed Resident 1 walking out of the building behind someone pushing a wheelchair. 3. Resident 1 interviewed on 06/30/2021 stated that "I can walk a long way; I walked all over the world and know how to read maps so I never got lost" and he recalled "a nice man gave me a ride back". Resident signed the Resident Handbook on 07/15/2019 that includes the procedure to sign in and out of the building and was unable to recall this requirement during interview. Wander device was observed on resident's left ankle during interview. 4. Resident 1's Uniform Assessment Instrument dated 04/5/2021 documents "wandering/passive weekly or more"; ISP dated 04/12/2021 documents resident "wears a wander guard" and "Private Duty Aide (PDA) walks with (resident) outside of building for safety and supervision". 5. Staff interview stated on 06/30/2021 that the facility learned after the incident that when the doors are already opened then the wander device is not activated so the facility was not alerted that the resident had exited.
Plan of Correction:	Not available online. Contact Inspector for more information.