VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Sunrise at Bluemont Park
5910 Wilson Boulevard
Arlington, VA 22205
(703) 536-1060

Current Inspector: Nina Wilson (703) 635-6074

Inspection Date: June 20, 2024

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 ACCOMMODATIONS AND RELATED PROVISIONS 22VAC40-73 BUILDINGS AND GROUND

Comments:

Type of inspection: Monitoring Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 06/20/2024 Time In: 10:58 AM Time Out: 3:00 PM The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. 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 Nina Wilson, Licensing Inspector at (703) 635-6075 or by email at nina.wilson@dss.virginia.gov.

Violations:

Standard #:	22VAC40-73-870-I
Description:	Based on facility record review, the facility failed to ensure that elevators, where used, shall be kept in good running condition, and shall be inspected at least annually. The signed and dated certificate of inspection issued by the local authority shall be evidence of such inspection. Evidence: 1. During a tour of the building and grounds, it was observed that the most recent inspection was not posted in the elevator. Staff 4 stated that the elevator inspection is housed at the front desk. On the way to the way to the front desk, Staff 4 advised that the elevator certificate would be expired but she was unsure of the reasoning. 2. The most recent inspection completed by a fire official was 05/28/2023.
Plan of Correction:	A. With respect to the specific situation cited: Community has all 3 elevators up-to-date with passing inspections. B. With respect to how the facility will identify situations with the potential for the identified concerns: Community will maintain the Certificate of Compliance and record of elevator Inspections at the front desk and Executive director's Office. Community will replace record of certification annually following inspection. C. With respect to what systematic measures have been put into place to address the citation: Certificate of Compliance and Record of Elevator Inspection has been placed at the front desk of each building & copy of each has been filed in the Executive Director's office. Community will maintain certificates at all locations to provide proof of compliance when requested. D. With respect to how the plan of correction will be monitored: During the Quality Assurance and Performance Improvement (QAPI) meeting and up to 3 months following the implementation of the POC, the Executive Director will review the POC and the results of the audit with the Department Coordinators. Additional improvement plans will be developed and implemented as necessary, including training to correct any deficient practices.
Standard #:	22VAC40-73-940-A
Description:	Based on facility records review and staff interview, the facility failed to ensure that at least an annual inspection by an appropriate fire official and reports of the inspection shall be retained at the facility for at least two years. Evidence: 1. The most recent inspection completed by a fire official was 10/18/2022. 2. On 06/20/2024, Staff 5 stated that ?there was a COVID outbreak in 2023. The fire marshal came out but when they were told about the outbreak, they turned around immediately.? Staff 5 further stated, ?I typically email or call Summit, who schedules the inspection for September or October. There?s nothing scheduled for this year, but I will call while you?re here.?
Plan of Correction:	A. With respect to the specific situation cited: Community received annual fire Marshal inspection with a passing inspection. B. With respect to how the facility will identify 1ations with the potential for the identified concerns: Maintenance Coordinator and Executive Director will ntain record of annual inspection. Maintenance Coordinator will contact Arlington County Fire Marshal's office 1 month prior to expiration to confirm scheduled inspection date C. With respect to what systemic measures have been put into place to address the citation: Maintenance Coordinator will schedule annual inspection for the coming year with fire Marshal as fire Marshal is present in community for the current year's annual inspection D. With respect to how the plan of correction will be monitored: During the Quality Assurance and Performance Improvement (QAPI) meeting and up to 3 months following the implementation of the POC, the Executive Director will review the POC and the results of the audit with the Department Coordinators. Additional improvement plans will be developed and implemented as necessary, including training to correct any deficient practices.
Standard #:	22VAC40-73-990-B
Description:	Based on facility records review, the facility failed to ensure that the procedures in the plan for resident emergencies shall be reviewed by the facility at least every six months with all staff. Documentation of the review shall be signed and dated by each staff person. Evidence: 1. On 06/20/2024, LI requested the resident emergency drills, but they were not provided. LI requested the drills at the start of the inspection, during the inspection, and prior to the tour, which occurred at the end of the inspection.
Plan of Correction:	A With respect to the specific situation cited: Community will host mandatory in-service & review of resident emergency plan every 6- months. 8. With respect to how the facility will identify situations with the potential for the identified concerns: Community will maintain record of resident emergency plan. Community will maintain record of resident emergency drills conducted. Maintenance Coordinator and Executive director will maintain record of resident emergency drills conducted. C. With respect to what systemic measures have been put into place to address the citation: Maintenance Coordinator and Executive director will schedule resident emergency drills very 6- months at community. Maintenance CoordinatL and Executive director will ensure participation of team members with drills and record participation with dated sign-in sheet. D. With respect to how the plan of correction will be monitored: During the Quality Assurance and Performance Improvement (QAPI) meeting and up to 3 months following the implementation of the POC, the Executive Director will review the POC and the results of the audit with the Department Coordinators. Additional improvement plans will be developed and implemented as necessary, including training to correct any deficient practices.