VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Sunrise of Fairfax
9207 Arlington Boulevard
Fairfax, VA 22031
(703) 691-0046

Current Inspector: Marshall Massenberg (804) 543-5188

Inspection Date: March 7, 2024

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:

Number of residents present at the facility at the beginning of the inspection: 57 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 4 Number of staff records reviewed: 4 Number of interviews conducted with residents: 2 Number of interviews conducted with staff: 5 Observations by licensing inspector: This LI observed residents participating in various activity programs and eating lunch. This LI observed a medication pass and compared physician orders to the medications available to administered to residents. LI reviewed fire inspection report, health inspection report, fire drills, emergency preparedness review with staff, emergency drills, healthcare oversight, medication review, dietary review and resident council minutes. 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 Sarah Pearson, Licensing Inspector at (540) 680-9469 or by email at sarah.pearson@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-640-A
Description:	Based on resident records review and staff interview, the facility staff failed to follow the facility?s medication management plan. Evidence: According to Resident D?s March 2024 Medication Administration Record, Liothyronine Sodium Oral Tablet 5 MCG, give 1 tablet by mouth in the morning for Hypothyroidism, prescribed 3/4/2024, was on hold March 4-9, 2024, pending physician approval. Facility staff did not document communication from the facility to the physician regarding the medication being on hold. Facility staff did not document the plan for correction of the issue leading to the missed dose.
Plan of Correction:	All 11 Wellness TM and MT will complete a refresher training on Sunrise?s medication management plan and specifically focus on the proper procedure to hold medications and communication with all parties involved and the importance of documenting the communication. Team members will complete an in-service on documentation. Quarterly Audit and random sampling of resident records to ensure compliance.