VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Sunrise of Vienna
374 Maple Avenue West
Vienna, VA 22180
(703) 272-6397

Current Inspector: Nina Wilson (703) 635-6074

Inspection Date: Jan. 25, 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 Buildings and Grounds Emergency Preparedness Mixed Population Safe, Secure Environment

Comments:

Date of Inspection: January 25, 2024 Type of Inspection: Renewal Inspection If you have any questions or email changes, please do not hesitate to contact me at laura.lunceford@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. Census 31 Number of records reviewed and interviews conducted- 8 records (staff and residents), 9 interviews. All facility self-reported incidents since the last inspection were reviewed on this date. The Licensing Inspector observed the residents during activities, snacks and meal times. The Licensing Inspector reviewed the following at the time of inspection: fire drills, emergency drills, pharmacy review, activity calendars and menus. The Licensing Inspector and the Administrator discussed the risk assessment ratings for the violations for this inspection. Please complete the ?plan of correction? and ?date to be corrected? for each violation cited on the violation notice and returned it to the office. You will need to specify how the deficient practice will be or has been corrected. Your plan of correction must contain: 1) steps to correct the noncompliance with the standard(s), 2) measures to prevent the noncompliance from occurring again; and 3) person(s) responsible for implementing each step and/or monitoring any preventive measure(s).

Violations:

Standard #:	22VAC40-73-250-C
Description:	Based on staff record review and staff interview, it was determined that the staff records were not complete as required. Evidence: Four of four staff records were missing personal and social data as required.
Plan of Correction:	It was identified that 4 team member files were missing required paperwork: demographic and social. The Business Office Coordinator completed and audit for the 4 team member charts previously reviewed and identified the missing required information. Team member files will be completed as per regulatory requirements. The Business Office Coordinator will complete an audit of all team member files and all corrections will be made. Additional training will be provided to the communities Business Office Coordinator on the required forms and the importance of the team member file being complete before the start of employment. The Executive Director/Business Office Coordinator will randomly audit new team member files to assure that the required paperwork had been completed. The results of the audit and plan of correction will be discussed during the Quality Assurance Performance Improvement meetings, with the Executive Director and the Management Team and changes will be made to the monitoring plan based on the results as needed.