VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Evermore Senior Living
4358 Prince William Parkway
Woodbridge, VA 22192
(703) 249-9128

Current Inspector: Sarah Pearson (540) 680-9469

Inspection Date: Jan. 12, 2023

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 Buildings and Grounds Emergency Preparedness

Comments:

Date of Inspection: January 12 and January 19, 2023 Type of Inspection: Monitoring 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 8 Number of records reviewed and interviews conducted- 6 records, 7 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 February 3, 2023

Violations:

Standard #:	22VAC40-73-950-E
Description:	Based on record review and staff interview, it was determined that the facility staff failed to conduct Emergency Preparedness Review with staff every six months. Evidence: Facility staff was unable to locate record of last review with staff within six months.
Plan of Correction:	Emergency Preparedness review is in progress with the staff in the facility; (e.g., Fire Evacuation, Call Light System, Life Safety, Severe Injuries, Inclement weather). The documentation of the review will be signed and dated by each staff person.
Standard #:	22VAC40-73-990-B
Description:	Based on record review and staff interview, it was determined that the facility failed to conduct Resident Emergencies Review with staff every six months. Evidence: Facility staff was unable to locate record of last review with staff within six months.
Plan of Correction:	Resident Emergency Review plan is in progress in the facility (e.g. Oxygen needs emergency, In the event a resident is missing, fire and emergency evacuation). The documentation of the review will be signed and dated by each staff person.