VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Eden Senior Care Services
15120 Enterprise Court, Suite 101
Chantilly, VA 20151
(703) 828-7545

Current Inspector: Jacquelyn Kabiri (703) 397-3017

Inspection Date: May 12, 2025

Complaint Related: No

Areas Reviewed:

22VAC40-61 PERSONNEL 22VAC40-61 PROGRAMS AND SERVICES 22VAC40-61 BUILDINGS AND GROUND 22VAC40-61 EMERGENCY PREPAREDNESS 63.2 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: 05/12/2025, 10:00 a.m. to 2:30 p.m. 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: 71 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: 0 Number of interviews conducted with staff: 2 Observations by licensing inspector: Lunch and activities Additional Comments/Discussion: None 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 Jacquelyn Kabiri, Licensing Inspector at (703) 397-3017 or by email at Jacquelyn.Kabiri @dss.virginia.gov

Violations:

Standard #:	22VAC40-61-50-D
Description:	Based on observation and interview, the center failed to ensure the posting of the name and telephone number of the appropriate regional licensing administrator of the department; the Adult Protective Services toll-free telephone number; the toll-free telephone number of the Virginia Long-Term Care Ombudsman Program and any local ombudsman program servicing the area; and the toll-free telephone number of the disability Law Center of Virginia. Evidence: 1. The facility did not have the name and telephone number of the regional licensing administrator, the Adult Protective Services toll-free telephone number; the toll-free telephone number of the Virginia Long-Term Care Ombudsman Program, or the toll-free telephone number of the disability Law Center of Virginia, displayed in the center. 2. Staff 1 stated they were unaware they needed this information posted. 3. Photo evidence taken.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-61-180-E-2
Description:	Based on staff record review and interview, the facility failed to ensure that each staff person obtained an evaluation for tuberculosis (TB) in a communicable form no earlier than 30 days before and no later than 7 days after employment or contact with participants. Evidence: 1. Staff 2, hired on 11/25/2024, did not have a TB evaluation or screening in their staff record. 2. Staff 3, hired 09/18/2023, did not have a TB evacuation or screening in their staff record. 3. Staff 1 was unable to provide the TB evaluations or screenings for staff 2 and staff 3 during the onsite inspection on 05/12/2025.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-61-300-E-2
Description:	Based on observation and interview, the facility failed to ensure that medications were labeled with participant?s names. Evidence: 1. The clinic room has wall cabinets containing medications that are unlabeled. 2. On 05/12/2025, the licensing inspector (LI), audited the wall cabinets in the clinic room. The cabinets contained 1 12 oz bottle of Pepto Bismol, 1 360 count bottle of Advil 200 mg, 1 bottle of Tums 96 count chewable tablets, 1 bottle of Tylenol 500 mg, 325 count without any participant or staff names on the bottles. 2. Staff 2 stated they were for participant use; however, staff 1 stated they were for staff use. 3. Photo evidence taken.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-61-410-E
Description:	Based on observations, the center failed to ensure that cleaning products, pesticides, or harmful materials, were stored and kept in a locked place when not in use. Evidence: 1. The laundry/storage room adjacent to the water fountain was unlocked. 2. The unlocked laundry/storage room had one large bottle of Clorox bleach, and liquid laundry soap and 1 bottle of Clorox cleaning spray out in the open. 3. The hallway leading to the exit door was observed to have 1 gallon size bottle of Antifreeze and Coolant propping a door open, and 1 can of Hot Shot bug spray in the corner of the hallway. 4. The activity room top cabinets were unlocked and contained the following: 1 bottle of Windex cleaner, 1 spray bottle of Lysol kitchen cleaner and 1 bottle of leather cleaner. 5. The activity room bottom cabinets were unlocked and contained the following: 2 19 oz cans of Lysol disinfectant spray, and 1 gallon of Bug Stop insect spray. 6. Staff 1 acknowledged the LI?s findings. 7. Photo evidence taken.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-80-120-E-2
Description:	Based on observation, the facility failed to ensure that the findings of the most recent inspection of the facility were posted in each facility. Evidence: 1. The center?s bulletin board had 1 posting of a completed inspection dated 06/12/2023. 2. The center?s bulletin board had 1 posting of a yellow inspection acknowledgement form, dated 07/14/2024, but not the final inspection forms. 3. Staff 1 confirmed the inspection findings. 4. Photo evidence taken.
Plan of Correction:	Not available online. Contact Inspector for more information.