VIRGINIA DEPARTMENT OF SOCIAL SERVICES

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

Current Inspector: Amanda Velasco (703) 397-4587

Inspection Date: July 22, 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 22VAC40-80 THE LICENSING PROCESS

Technical Assistance:

N/A

Comments:

Type of inspection: Renewal Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 07/22/2025 9:40 AM to 12:30 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: 74 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: 4 Number of interviews conducted with participants: 2 Number of interviews conducted with staff: 2 Observations by licensing inspector: AM Snack, Activities, Lunch Meal 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 #:	22VAC40-61-50-E
Description:	Based on participant record review and staff interview, the center failed to ensure that the rights and responsibilities of participants were reviewed annually with each participant and/or their legal representative if a participant is unable to fully understand and exercise his rights and responsibilities. Evidence: 1. The following participant records did not contain an annual review of the rights and responsibilities of participants a. Participant 2, admitted 02/13/2024 b. Participant 4, admitted 01/03/2023 c. Participant 5, admitted 04/29/2024 d. Participant 6, admitted 09/14/2022 2. In an interview with the LI on 07/22/2025, Staff 1 and 2 confirmed that the rights and responsibilities of participants were not reviewed annually for Participant 2, Participant 4, Participant 5, and Participant 6.
Plan of Correction:	We already asked all participants reviewed and signed the RIGHTS AND RESPONSIBILITIES, and will continue to ask them to review and sign annually in the future time.
Standard #:	22VAC40-61-90-A
Description:	Based on participant record review and staff interview, the center failed to ensure that any major incident that has negatively affected or threatened the life, health, safety, or welfare of any participant was reported to the regional licensing office within 24 hours of the occurrence. Evidence: 1. Upon review of the written resident emergencies binder, the LI reviewed the following incident reports: a. On 03/24/2025, Resident 8 arrived to the center with bruises on the face and continued to have swelling throughout the day. Resident 8 was sent to receive medical attention by emergency services. b. On 05/05/2025, Resident 7 hit their head on the door and formed a bruise and was sent home. 2. In an interview with the LI on 07/22/2025, Staff 1 and 2 confirmed that the incidents were not reported to the regional licensing office within 24 hours of the occurrence.
Plan of Correction:	We will report the incidents to the regional licensing office within 24 hours of the occurrence in the future time.
Standard #:	22VAC40-61-110-A
Description:	Based on staff record review and staff interview, the facility failed to ensure that all staff received training in the participant rights and responsibilities prior to working directly with participants. Evidence: 1. The following staff records did not contain participant rights and responsibilities training: a. Staff 3, hired 05/15/2025 b. Staff 4, hired 09/01/2016 c. Staff 5, hired 01/16/2023 d. Staff 6, hired 03/20/2017 2. In an interview with the LI on 07/22/2025, Staff 1 and 2 confirmed that that Staff 3, Staff 4, Staff 5, and Staff 6 did not complete training on the participant rights and responsibilities prior to working directly with participants.
Plan of Correction:	All stuffs already received training in the participant rights and responsibilities prior to working directly with participants after inspection. We will request new stuff to follow this requirement in the future time.
Standard #:	22VAC40-61-150-A
Description:	Based on staff record review and staff interview, the center failed to ensure that all staff who provide direct care to participants attended at least 12 hours of training annually. Evidence: 1. The following staff records did not contain 12 hours of annual training: a. Staff 4, hired 09/01/2016 b. Staff 5, hired 01/16/2023 c. Staff 6, hired 03/20/2017 2. In an interview with the LI on 07/22/2025, Staff 1 and 2 confirmed that that Staff 4, Staff 5, and Staff 6 did not have the required 12 hours of annual training.
Plan of Correction:	We have already finished the 12 hours training for all the staff and will do the 12 hours of training annually in the future time.
Standard #:	22VAC40-61-520-C
Description:	Based on participant record review, staff record review, and staff interview, the center failed to ensure that a semi-annual review on the emergency preparedness and response plan was developed and implemented for all staff and participants. Evidence: 1. The LI requested a copy of the semi-annual review of the semi-annual review on the emergency preparedness and response plan. 2. In an interview with the LI on 07/22/2025, Staff 1 and 2 confirmed that that a semi-annual review on the emergency preparedness and response plan was not developed and implemented for all staff and participants.
Plan of Correction:	All stuffs and participants already done for the emergency preparedness and response plan, We will do this plan semi-annual in the future time.