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: Jan. 26, 2023

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 GROUNDS 22VAC40-61 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

Technical Assistance:

Please update the Participant Rights posting to the most recent form dated 3/20 from the DSS website. Please update the Fire Drill Form the most recent form dated 3/20 from the DSS website. Please ensure that the most recent Violation Notice is posted in a conspicuous place ? for example, next to the posted License.

Comments:

An unannounced monitoring inspection was conducted on 1/26/2023. At the time of entrance there were approximately 39 participants in care and seven staff members providing supervision. The Licensing Inspector completed a tour of the physical plant that included the building and grounds of the facility. Four participant and four staff records were reviewed. Participant interviews were not conducted because the participants? first language is not English and no interpreters were provided No participants received medications during the inspection. Participants were observed having a snack. Activities observed included current events, traditional games, massage therapy and morning exercise. Criminal Background Checks of all staff hired since previous inspection were 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. 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 #:	22VAC40-61-260-A
Description:	Based on documentation review and interview the center failed to ensure that within the 30 days preceding admission, a participant shall have a physical examination by a licensed physician. Evidence: Participants #1, #2, #3, and #4 did not have documentation of a physical exam in the participant record
Plan of Correction:	Center Nurse will review all participant records to ensure that a physical exam has been completed in the last year. All new clients will not be admitted until the physical is received.
Standard #:	22VAC40-61-410-E
Description:	Center failed to ensure that cleaning products, pesticides, and all poisonous or harmful materials shall be stored separately from food and shall be kept in a locked place when not in use. Evidence: Upon Licensing Inspector?s arrival the cleaning supply closet was observed to be open and unlocked.
Plan of Correction:	Center Director will hold training with staff to ensure that all staff are aware of the requirement to close and lock the cleaning supply door.
Standard #:	22VAC40-61-460-I
Description:	Center failed to ensure that there shall be an adequate supply of toilet tissue, liquid soap, disposable hand towels, or air dryers and disposable gloves in each restroom at all times. Evidence: Upon Licensing Inspector?s arrival there was not a supply of disposable gloves in the men or women?s restroom.
Plan of Correction:	Gloves were removed from the restrooms due to clients taking the gloves for home use. Center will install locked cabinet to store gloves so they are available to staff.