Pacifica Senior Living Sterling
46555 Harry Byrd Highway
Sterling, VA 20164
(703) 896-9590
Current Inspector: Marshall Massenberg (804) 543-5188
Inspection Date: Sept. 27, 2022
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
22VAC40-73 EMERGENCY PREPAREDNESS
ARTICLE 1 ? SUBJECTIVITY
32.1 REPORTED BY PERSONS OTHER THAN PHYSICIANS
63.2 GENERAL PROVISIONS
63.2 PROTECTION OF ADULTS AND REPORTING
63.2 LICENSURE AND REGISTRATION PROCEDURES
63.2 FACILITIES AND PROGRAMS
22VAC40-90 BACKGROUND CHECKS FOR ASSISTED LIVING FACILITIES
22VAC40-90 THE SWORN STATEMENT OR AFFIRMATION
22VAC40-90 THE CRIMINAL HISTORY RECORD REPORT
22VAC40-80 THE LICENSE
22VAC40-80 THE LICENSING PROCESS
22VAC40-80 COMPLAINT INVESTIGATION
22VAC40-80 SANCTIONS
- Technical Assistance:
-
A completed Renewal Application must be submitted prior to the expiration of the current license. The facility should receive an application in the mail, however if an application has not been received one can be obtained from the DSS web site or by calling the main office at (276) 206-0492.
- Comments:
-
Type of inspection: Renewal
Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: LI entered the facility at 8:43 am on 9/27/2022 and exited the facility at 3:00 pm on 9/27/2022.
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: 52
The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility.
Number of resident records reviewed: 8
Number of staff records reviewed: 4
Number of interviews conducted with residents: 1
Number of interviews conducted with staff: 2
Observations by licensing inspector: LI observed medication administration. LI observed residents eating lunch and engaging in activities.
Additional Comments/Discussion:
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 Jamie Eddy, Licensing Inspector at (703) 479-5247 or by email at jamie.eddy@dss.virginia.gov
- Violations:
-
Standard #: 22VAC40-73-250-D Description: Based upon a review of records, the facility failed to ensure each staff person on or within seven days prior to the first day of work at the facility shall submit the results of a risk assessment, documenting the absence of tuberculosis in a communicable form as evidenced by the completion of the current screening form published by the Virginia Department of Health or a form consistent with it. The risk assessment shall be no older than 30 days.
Evidence: The date of hire for Staff #4 was 4/11/2022. The tuberculosis risk assessment in the record for Staff #4 was dated 5/11/2021.Plan of Correction: Executive Director (ED) and Business Office Manager (BOM) will audit all staff personnel files to ensure all TB screenings are up to date by 10/31/2022. All chest x-rays and TB test results for new hires will be accompanied by the updated TB Risk Assessment Form. Annual TB Risk Assessment for all staff and residents will make use of updated form as well. Semiannual audit will be performed by ED and BOM.
Standard #: 22VAC40-73-680-I Description: Based upon a review of records and interviews, the facility failed to ensure that the Medication Administration Record (MAR) includes: any medications errors or omissions.
Evidence: 1. According to an email from a collateral contact, on 9/9/2022 at approximately 3 pm and on 9/23/2022 at approximately ?staff attempted 3x to give medication (to Resident #6) and resident asked staff to go away but the staff didn?t go back to document.?
2. According to the MAR, Resident #1 did not receive the 3 pm dosage of Clonazepam 0.5 mg on 9/9/2022 and 9/23/2022. The MAR does not include a reason for the omissions. 3. LI interviewed the administrator and the collateral contact and was told by both parties that Resident #6 does have a history of refusing medicationsPlan of Correction: On 9/28/2022, RSD (Resident Services Director) conducted in-service on the following:
1.Proper administration and documentation of medication refusal. 2.Reviewing electronic MAR for all administered medication and medication refusal.
On 9/28/2022, RSD completed a med pass audit to ensure compliance. Audits will continue weekly if noncompliance is observed
Disclaimer:
This information is provided by the Virginia Department of Social Services, which neither endorses any facility nor guarantees that the information is complete. It should not be used as the sole source in evaluating and/or selecting a facility.
This information is provided by the Virginia Department of Social Services, which neither endorses any facility nor guarantees that the information is complete. It should not be used as the sole source in evaluating and/or selecting a facility.