VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Arlington Adult Day Program
2909 16th Street, South
Arlington, VA 22204
(703) 228-5340

Current Inspector: Nina Wilson (703) 635-6074

Inspection Date: Sept. 11, 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. 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:

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: 9/11/23 (11:10 AM - 3:25 PM) The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. At the time of entrance, 16 participants were present. Participants, staff records, and other documentation were reviewed. No new staff members were hired since the previous inspection. Participants were observed eating lunch and engaging in activities. Medication administration was observed. 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. 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. 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 (703) 431-4247 or by email at m.massenberg@dss.virginia.gov.

Violations:

Standard #:	22VAC40-61-160-A-1
Description:	Based on documentation and interview, the center failed to ensure that each direct care staff member maintainscurrent certification in first aid from the American Red Cross, American Heart Association, National Safety Council, American Safety and Health Institute, community college, hospital, volunteer rescue squad, or fire department. Evidence: The record, for Staff #3 (hired 8/24/15), was reviewed during the inspection. Staff #3's record contained documentation of current CPR certification, but it did not include First Aid. Facility staff confirmed that Staff #3's First Aid was not current, at the time of the inspection.
Plan of Correction:	All staff will be compliant with 22VAC40-60-160-A-1, completing basic first aide.
Standard #:	22VAC40-61-360-D
Description:	Based on observation and documentation, the center failed to ensure that food is prepared and served according to the physician's or prescriber's orders, when such a diet is prescribed for a participant. Evidence: Participant #2 was observed eating a lunch meal that was consistent with a mechanical soft diet. The most recent diet order, included in Participant #2's record, was noted on her physical examination form (dated 7/27/23). The form indicated that Participant #2 needs a pureed diet.
Plan of Correction:	A written order was received by the doctor that allows participant to have hand chopped, moist meals, including bread.
Standard #:	22VAC40-61-520-C
Description:	Based on interview, the center failed to provide documentation of the semi-annual review of the emergency preparedness and response plan for all staff, participants, and volunteers. Evidence: Documentation of the most recent semi-annual review of the emergency preparedness plan (with staff, participants, and volunteers) was requested during the inspection. No documentation was provided, during the inspection, to confirm that the emergency preparedness and response plan was reviewed with all staff, participants, and volunteers within the past six months.
Plan of Correction:	Training for staff and participants will be documented semi-annually on the emergency preparedness plan. Logs have been created to capture the trainings.