VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Vienna Manor V, LLC
1416 Carrington Lane
Vienna, VA 22182
(703) 493-1150

Current Inspector: Alexandra Roberts

Inspection Date: March 23, 2023

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 ACCOMODATIONS AND RELATED PROVISIONS 22VAC40-73 BUILDING AND GROUNDS 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:

Discussed the use of video monitors during the overnight shift in the resident rooms. The facility will create a policy to be used in each facility.

Comments:

An unannounced renewal inspection was conducted on 3/23/2023. At the time of entrance seven residents were in care with three staff providing care. The sample size consisted of four resident records, three staff records and one individual interview. Resident and staff records and other documentation were reviewed. Virginia State Police background checks reviewed for all new staff hired since the previous inspection conducted on 12/30/2022. Residents were observed eating breakfast and lunch and engaging in activities including current events and exercise. Medication administration was reviewed. An exit meeting was 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 Lynette Storr, Licensing Inspector at (703) 479-4708 or by email at lynette.storr@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-325-A
Description:	Based on documentation review and interview the facility failed to ensure that for residents who meet the criteria for assisted living care, by the time the comprehensive ISP is completed, a written fall risk rating shall be completed. Evidence: Currently the facility completes the fall risk rating when a resident experiences a fall. The fall risk rating is required to be completed at minimum at admission and annually.
Plan of Correction:	The Administrator will implement the standard practice of documenting the fall risk rating upon a resident?s admission, annually and when a resident experiences a fall.
Standard #:	22VAC40-73-450-C
Description:	Based on documentation review and interview the facility failed to ensure that the comprehensive Individualized Service Plan (ISP) shall include a written description of what services will be provided to address identified needs and who will provide them. Evidence: Resident #3?s most recent ISP dated 10/3/2022 did not include details regarding the assessed need for assistance with oxygen and hospice services.
Plan of Correction:	The Administrator will review all ISPs to ensure all services are detailed on each resident?s ISP