VIRGINIA DEPARTMENT OF SOCIAL SERVICES

The Hillside House Assisted Living Memory Care Community
20501 Earhart Place
Sterling, VA 20165-3581
(703) 404-5186

Current Inspector: Amanda Velasco (703) 397-4587

Inspection Date: Nov. 23, 2022

Complaint Related: No

Areas Reviewed:

22VAC40-73 STAFFING AND SUPERVISION 22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS

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: LI entered the facility at 10:49 am on 11/23/2022 and exited the facility at 1:00pm on 11/23/2022. The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. A self-reported incident was received by VDSS Division of Licensing on 11/15/2022 and 11/19/2022 regarding allegations in the area(s) of: staffing and supervision, resident care and related services, and additional requirements for facilities that care for adults with serious cognitive impairments. Number of residents present at the facility at the beginning of the inspection: 7 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 2 Number of staff records reviewed: 0 Number of interviews conducted with residents: 0 Number of interviews conducted with staff: 2 Observations by licensing inspector: LI observed the exits that led to residents leaving the building. Additional Comments/Discussion: An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation supported some, but not all of the self-report area(s) of non-compliance with standard(s) or law were: additional requirements for facilities that care for adults with serious cognitive impairments. A violation notice was issued; any violation(s) not related to the self-report but identified during the course of the investigation can also be found on the violation notice. 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 #:	22VAC40-73-1150-A
Description:	Based upon a interviews and observation of the physical building, the facility failed to ensure that doors that lead to unprotected areas shall be monitored or secured. Evidence: 1. Licensing Inspector (LI) observed on 11/23/2022 that the door located inside of the kitchen area that leads directly to an unprotected area outside of the building does not have a lock or monitoring system to prevent residents on the secured care unit from exiting. 2. According to the interview conducted on 11/23/2022 with the administrator, Resident #1 was able to exit the common area/serving at approximately 1:35 pm on 11/13/2002 due to a door located in the serving area of the kitchen being ?propped open.? The administrator indicated that the door that was propped open, ?when shut, is locked and can only be unlocked with the use of an electronic key.? According to the administrator, Resident #1 then exited the building through a door that ?does not have a lock? and that the door allowed Resident #1 to exit the facility and enter an area outside of the building that is unprotected.
Plan of Correction:	1. No residents were harmed as a result of the alleged deficient practice. On the spot staff education completed on maintaining a secure environment. 2. Resident #1 was put on a 1:1 care, this will continue until the door is made secure. 3. All residents have the potential to be affected by this alleged deficient practice. The door that leads outside will have a secure locking mechanism put on. Staff assigned to Hillside House will be re-educated on safety and security. 4. The AL Administrator or designee will coordinate with the Security department on getting the door secure. Any breaches will be recorded monthly x3 and discussed with the Quality Assurance Committee. A quarterly summary report will be provided to the Quality Assurance Committee.