VIRGINIA DEPARTMENT OF SOCIAL SERVICES

The Kensington Reston
11501 Sunrise Valley Drive
Reston, VA 20191
(571) 494-8100

Current Inspector: Marshall Massenberg (804) 543-5188

Inspection Date: July 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 Building and Grounds Emergency Preparedness Additional Requirements for Facilities that Care for Adults with Cognitive Impairments Background Checks for Assisted Living Facilities Sworn Statement

Comments:

Date of Inspection: July 12, 2023 Type of Inspection: Monitoring inspection Census 78 Number of records reviewed and interviews conducted- 9 records, 5 interviews. All facility self-reported incidents since the last inspection were reviewed on this date. The LI observed resident involved in a variety of activity programs and eating lunch. Licensing Inspector also observed a medication administration pass. 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. 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).

Violations:

Standard #:	22VAC40-73-450-C
Description:	Based on resident record review and staff interview, it was determined that the facility did not have a coordinated plan of care for Resident C or D. Evidence: Resident C's Individualized Service Plan did not include that he had a wound and Resident D's Individualized Service Plan did not include that she was receiving home health therapy services.
Plan of Correction:	1. Home Health Services added to Resident C's Individualized Service Plan for his wound care. Therapy Services were added to Resident D's Individualized Service Plan. 2. An audit of Individualized Service Plans for residents receiving home health and/or therapy services will be conducted by the licensed nurse or designee to ensure that these services are included on the residents' service plans. Such services not included on residents' Individualized Service Plans will be corrected. Director or designee to educate designated team members on practices related to the inclusion of home health and/or therapy services within the residents' Individualized Service Plans. 3. A 100% audit of Individualized Service Plans for residents receiving home health and/or therapy services will be conducted by Director or designee, monthly for 3 months, to ensure that such services are listed on the service plans. Corrective action will be initiated for any variances and findings will be reported to the Executive Director. Person responsible: Executive Director or designee (11/30/23)