VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Morningside House of Leesburg
316 Harrison Street, SE
Leesburg, VA 20175
(703) 777-2777

Current Inspector: Amanda Velasco (703) 397-4587

Inspection Date: June 6, 2024

Complaint Related: No

Areas Reviewed:

22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-73 RESIDENT ACCOMMODATIONS AND RELATED PROVISIONS 22VAC40-73 EMERGENCY PREPAREDNESS

Technical Assistance:

Reviewed Incident Report Guidelines

Comments:

Type of inspection: Monitoring Date of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 06/06/2024, 1:25 PM to 3:00 PM The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. Number of residents present at the facility at the beginning of the inspection: 64. Number of resident records reviewed: 0 Number of staff records reviewed: 0 Number of interviews conducted with residents: 1 Number of interviews conducted with staff: 3 Additional Comments/Discussion: N/A An exit meeting will be conducted to review the inspection findings. The evidence gathered during the inspection determined non-compliance with applicable standard(s) or law, and violation(s) were documented on the violation notice issued to the facility. The licensee has the opportunity to submit a plan of correction to indicate how the cited violation(s) will be addressed in order to return the facility to compliance and maintain future compliance with applicable standard(s) or law. If the licensee wishes to provide a plan of correction: (i) type the plan on a separate Word document, (ii) identify the standard violation number being addressed, (iii) include the date the violation will be corrected, (IV) do not include any names or confidential information, and (V) return to the licensing inspector by email within five (5) business days of the exit interview. Compliance with all applicable regulations and law shall be maintained and any areas of noncompliance must be corrected. Within 15 calendar days of your receipt of the inspection findings (inspection summary, violation notice, and supplemental information), you may request a review and discussion of these findings with the inspector's immediate supervisor. To make a request for review and discussion, you must contact the licensing supervisor at the regional licensing office that serves your geographical area. Regardless of whether a supervisory review has been requested, the results of the inspection will be posted to the DSS public website within 5 business days of your receipt of the Inspection Summary and/ or Violation Notice. The department's inspection findings are subject to public disclosure. Please Note: A copy of the findings of the most recent inspection are required to be posted on the premises of the facility. For more information about the VDSS Licensing Programs, please visit: www.dss.virginia.gov Should you have any questions, please contact Amanda Velasco, Licensing Inspector at (703) 397 4587 or by email at Amanda.Velasco@dss.virginia.gov.

Violations:

Standard #:	22VAC40-73-950-B
Description:	Based on facility document review, the facility failed to ensure a description of the generator's capacity to provide sufficient power for the operation of lighting, ventilation, temperature control, supplied oxygen, and refrigeration was included in it?s emergency preparedness and response plan. Evidence: 1. Staff 1 provided a copy of the emergency response plan and the emergency generator policy. 2. The policy stated ?Areas serviced by this generator during times of main power outage include elevator(s), hallway lighting, limited kitchen equipment, resident emergency call system, facility office phone system, and designated wall receptacles (identified with a sticker)? 3. Staff 1, 2, and 3 confirmed that the generators serviced all of the areas described in the plan but did not service the temperature control and supplied oxygen.
Plan of Correction:	Emergency Preparedness and Response Plan did not include a description of the generator?s capacity and areas that it services when in use. The generator services elevator, hallway lighting, ventilation, heating and cooling systems, limited kitchen equipment, resident emergency call system, facility office phone system and designated common area wall receptacles (identified with a sticker) to be used in powering supplied oxygen as needed. Residents on oxygen (2) were switched over to tank operation for resident comfort in their apartments in lieu of relocating resident and oxygen concentrator to common areas. Generator vendor has been scheduled to verify equipment to ensure all areas of the Emergency Plan are serviced by the generator. Emergency Plan has been updated to include the power capacity of the generator and all areas it services in the event of an outage.
Standard #:	22VAC40-73-950-H
Description:	Based on staff interview, the facility failed to notify family members and legal representatives after the emergency was stabilized and reported to the regional licensing office by the next day. Evidence: 1. Staff 1 stated that there was a town-wide power outage on Monday, May 27th, 2024 that lasted from 6:30 AM to roughly 3:30 PM where emergency generators were in use. 2. Staff 1 stated that there was no notification to families at any point during the power outage or after. 3. Staff 1 stated that there was a town-wide power outage on Monday, May 27th, 2024, that lasted from 6:30 AM to roughly 3:30 PM where emergency generators were in use. 4. Staff 1 confirmed that the incident was not reported to the regional licensing office.
Plan of Correction:	There was a town wide power outage at 6:30 am on May 27, 2024 that lasted for approximately 3 hours at which time the community generator provided power to the community. When the main power was restored at 9:30 am, the generator continued to provide power to the community rather than switching back to main power. The generator vendor was notified immediately and dispatched to switch back to main power. Main power source was restored at 3:30 pm. Residents were safe and virtually unaffected by outage and resident families were not notified. Community will notify resident families in the future in the event of a power outage or other emergency. Residents were safe and virtually unaffected by outage and regional licensing office was not notified. Community will notify regional licensing office in the future in the event of a power outage or other emergency.