VIRGINIA DEPARTMENT OF SOCIAL SERVICES

NOVA Adult Day Care Center Inc.
44675 Cape Court
Suite 130
Ashburn, VA 20147
(703) 433-8888

Current Inspector: Laura Lunceford (540) 219-9264

Inspection Date: June 17, 2019

Complaint Related: No

Areas Reviewed:

22VAC40-60 ADMINISTRATION 22VAC40-60 PERSONNEL. 22VAC40-60 SUPERVISION. 22VAC40-60 BUILDINGS AND GROUNDS. 22VAC40-60 ADMISSION, RETENTION AND DISCHARGE. 22VAC40-60 PROGRAMS AND SERVICES. 22VAC40-60 EMERGENCY PREPAREDNESS. 22VAC40-80 THE LICENSE. 22VAC40-80 THE LICENSING PROCESS. 22VAC40-80 SANCTIONS. 63.2 General Provisions. 63.2 Protection of adults and reporting. 63.2 Licensure and Registration Procedures 63.2(19.2) Criminal Procedures. 22VAC40-90 Background Checks for Assisted Living Facilities 22VAC40-90 The Sworn Statement or Affirmation 22VAC40-90 The Criminal History Record Report

Comments:

An unannounced renewal study was conducted 6/17/19. At the time of entrance there were approximately 14 participants in care and three staff members providing supervision. Three participant and two staff records were reviewed. No participants received medications during the inspection. Participants were observed disembarking from the van and having breakfast. Activities observed included traditional games, computer learning and morning exercise. Criminal Background Checks of all staff hired since previous inspection conducted on 4/23/19were reviewed. Participant interviews were not conducted because the participants? first language is not English and no interpreters were provided. Violation notice issued with the assessed risk reviewed and exit interview held. Thank you for your cooperation and if you have any questions please call 703-479-4708 or contact me via e-mail at lynette.storr@dss.virginia.gov.

Violations:

Standard #:	22VAC40-60-90-A
Description:	Licensee failed to ensure compliance with all regulations for licensed adult day care centers and terms of the license issued by the department; with other relevant federal, state or local laws and regulations; and with the center's own policies. Evidence: Participant #2's physical dated 5/23/18 indicates that the resident is non-ambulatory. The terms of the day care license requires that all participants be assessed as ambulatory.
Plan of Correction:	Center Director will acquire updated physical documenting current ambulatory status.
Standard #:	22VAC40-60-600-A
Description:	Center failed to ensure that the report of the required physical examination shall include: All diagnoses and significant medical problems; A list of all medications including dosages, route, and frequency of administration; Any special diet or any food intolerances; Any allergies such as, but not limited to, medication allergies, food allergies, animal allergies; Any therapy, treatments or procedures the individual is undergoing or should receive, and by whom; A statement that the individual is or is not capable of administering his own medications without assistance; and a statement that the individual is or is not physically and mentally capable of self-preservation by being able to respond in an emergency, either to an area of safe refuge or from the building, without the assistance of another person, even if he may require the assistance of a wheelchair, walker, cane, prosthetic device, or a single verbal command. Evidence: Participant #3's physical dated 5/30/18 did not document all of the required information.
Plan of Correction:	Center Director will acquire updated physical documenting all of the required information.
Standard #:	22VAC40-60-610-A-1
Description:	Center failed to ensure that each participant shall annually submit a report of physical examination by a physician including the information required in subdivisions B 1 through 5 and B 7 of 22??A VAC 40-60-600 (annual screening for tuberculosis is not required for participants). Evidence: Resident #2's most recent physical exam is dated 5/23/18 - that is not within the annual timeline requirements.
Plan of Correction:	Center Director will review all records to ensure physical exams are completed annually.