VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Insight Memory Care Center
3953 Pender Drive
Suite 100
Fairfax, VA 22030
(703) 270-0044

Current Inspector: Jacquelyn Kabiri (703) 397-3017

Inspection Date: April 2, 2025

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 GROUND 22VAC40-61 EMERGENCY PREPAREDNESS 22VAC40-90 THE SWORN STATEMENT OR AFFIRMATION 22VAC40-90 THE CRIMINAL HISTORY RECORD REPORT

Technical Assistance:

Medication Labels

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: 04/02/2025 8:45 AM to 1:25 PM The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. Number of participants present at the facility at the beginning of the inspection: 56 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of participant records reviewed: 6 Number of staff records reviewed: 3 Number of interviews conducted with participants: 2 Number of interviews conducted with staff: 6 Observations by licensing inspector: Activities, Meals, Medication Pass Additional Comments/Discussion: N/A 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 Amanda Velasco, Licensing Inspector at (703) 397 4587 or by email at Amanda.Velasco@dss.virginia.gov

Violations:

Standard #:	22VAC40-61-200-A
Description:	Based on direct observation and staff interview, the facility failed to ensure there was at least one staff person on duty providing direct care for every six participants in care. Evidence: 1. On 04/02/2025 around 9:40 am, the LI observed a staff meeting being conducted in a room adjacent to the main dining/ large group activity area. Staff 2 was checking residents in to the center, while approximately 22 residents completed activities or ate breakfast. There was no staff available in the room to provide direct care. 2. In an interview with the LI, Staff 2 stated that the meeting occurred every day from approximately 9:30 to 9:50 AM. 3. In an interview with the LI, Staff 1 acknowledged direct care was not available to residents during the time staff are away in the staff meeting.
Plan of Correction:	*Corrective Action Taken: An immediate recruitment campaign was implemented to hire additional qualified staff members to meet the state requirements that there shall be at least one staff person on duty providing direct care and supervision for every six participants in care, or portion thereof, whether at the center or on field trips. *Systemic Change: To improve staff retention IMCC will evaluate and enhance em-ployee engagement and satisfaction programs. Responsible Party: HR and Executive Director Monitoring: Review and adjust staff scheduling procedures to ensure staffing levels meet regulatory requirements.
Standard #:	22VAC40-61-330-G-4
Description:	Based on direct observation, facility document review, and staff interview, the facility failed to ensure that the schedule included the name, type, date, and hour of the activity and included any changes or substitutions. Evidence: 1. On 04/02/2025, the LI observed three posted schedules for the corresponding groups in the facility. The schedules were as follows ? 2. The Blue Group Schedule: a. 7:30 Group Discussion (S) b. 8:00 Personal Active Stations (C) (CR) c. 8:30 Table Talk Discussions (S) d. 9:00 Group Brain Games (C) e. 9:30 Music Selections (S) (SE) 3. The Coral Group Schedule: a. 7:30 Music Reflections (SE) b. 8:00 Coffee and Chat (S) c. 8:30 Current Events Discussion (C) d. 9:00 Group Brain Games (C) e. 9:30 Music Selections & Puzzles (SE) (C) 4. The Orange Group Schedule: a. 7:30 Music Reflections (SE) b. 8:00 Coffee & Chat (S) c. 8:30 Current Events Discussion (C) d. 9:00 Group Brain Games (C) e. 9:30 Music Selections & Puzzles (SE) 5. On 04/02/2025 around 9:15 AM, the LI observed all participants in the large group activity area working on various tasks such as breakfast, coloring, listening to music, and reading. 6. In an interview with the LI, Staff 3 stated that the activities listed are all options that can be pulled out, and not separate activities as listed. 7. In an interview with the LI, Staff 1 confirmed that the schedule does not accurately show the schedule of events by type, hour, and name.
Plan of Correction:	*Corrective Action Taken: The monthly activity calendar has been revised to reflect a wider range of engagement levels, including more sensory and one-on-one offerings. *Systemic Change: The Activities team will conduct monthly planning sessions to ensure programming meets the cognitive needs of all participants. Documentation of engagement will be reviewed weekly. *Responsible Party: Activities Coordinator and Clinical Team *Monitoring: Ongoing monthly review of activities and their alignment with partici-pant needs across all stages of dementia.
Standard #:	22VAC40-61-410-A
Description:	Based on direct observation and staff interview, the facility failed to ensure the exterior of the building was maintained in good repair. Evidence: 1. On 04/02/2025, the LI observed a hole in the awning at the entrance of the facility. 2. In an interview with the LI, Staff 1 confirmed that the awning was not in good repair. 3. Photo evidence obtained.
Plan of Correction:	Corrective Action Taken: Insight Memory Care Center has contracted with Collateral Contact 1. Final proposal signed 4/23/25 with an estimated date for installment of July 2025.