VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Brightview Fair Oaks
12725 Lee Hwy
Fairfax, VA 22030
(571) 495-5907

Current Inspector: Marshall Massenberg (804) 543-5188

Inspection Date: Oct. 17, 2024

Complaint Related: No

Areas Reviewed:

22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES 22VAC40-73 PERSONNEL 22VAC40-73 STAFFING AND SUPERVISION 22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-73 BUILDING AND GROUNDS

Technical Assistance:

Documentation was discussed with the provider.

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: 10/17/24 (8:30 AM - 12:30 PM). The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: Two Number of interviews conducted with residents: One Number of interviews conducted with staff: Two Observations by licensing inspector: Medication administration, Building and Grounds 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 Marshall Massenberg, Licensing Inspector at (804) 543-5188 or by email at Marshall.x.Massenberg@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-680-D
Description:	Based on observation and documentation, the facility did not ensure that medications are administered in accordance with the physician's instructions. Evidence: 1. The medication pass for Resident #1 was observed during the inspection. 2. Resident #1's Levothyroxine was administered along with her other 8:00 AM medications. Resident #1's October medication administration record (MAR) lists her Levothyroxine?s administration time as 8:00 AM, since 10/10/24. Prior to 10/10/24, Resident #1's Levothyroxine was scheduled for 7:00 AM. 3. Resident #1's record contained an order for Levothyroxine, signed 9/5/24, that calls for the medication to be administered 1 hour "prior to AM meds."
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-680-M
Description:	Based on observation and interview, the facility did not ensure that PRN medications are available and properly stored at the facility. Evidence: 1. PRN Loperamide and Ondansetron, ordered for Resident #2, were not present at the time of the medication cart inspection. 2. Facility staff confirmed that the medications were not present, at the time of the medication cart inspection.
Plan of Correction:	Not available online. Contact Inspector for more information.