VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Pivotal Assisted Living
6006 Hibbling Avenue
Springfield, VA 22150
(301) 503-1706

Current Inspector: Alexandra Roberts (804) 845-6956

Inspection Date: March 7, 2024

Complaint Related: No

Areas Reviewed:

22VAC40-61 GENERAL PROVISIONS 22VAC40-61 ADMINISTRATION 22VAC40-61 PERSONNEL 22VAC40-61 SUPERVISION 22VAC40-61 ADMISSION, RETENTION AND DISCHARGE 22VAC40-61 PROGRAMS AND SERVICES 22VAC40-61 BUILDINGS AND GROUND 22VAC40-61 EMERGENCY PREPAREDNESS 22VAC40-90 THE SWORN STATEMENT OR AFFIRMATION 22VAC40-90 THE CRIMINAL HISTORY RECORD REPORT

Technical Assistance:

Advised ED to ensure that UAI and ISP match correctly for specific areas of needs in regards to ADLs. (Specifics provided to ED)

Comments:

Date of Inspection: March 7, 2024 10am - 12pm Type of Inspection: Monitoring inspection Census 1 Number of records reviewed and interviews conducted - 2 records & 1 interview. All facility self-reported incidents since the last inspection were reviewed on this date. The LI observed resident watching TV and eating a snack. The evidence gathered during the inspection determined no violations with applicable standard(s) or law. The inspection summary will be posted to the VDSS website within five (5) business days of your receipt of the inspection summary. 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. If you have any questions or email changes, please do not hesitate to contact me at Alexandra.n.roberts@dss.virginia.gov. If you need a copy of any of the DSS Model forms or to review any inspection or regulation, you can find the information on the internet: www.dss.virginia.gov.