VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Herndon Harbor Adult Day Health Care Center
875 Grace Street
Herndon, VA 20170
(703) 435-8729

Current Inspector: Ishmel Paige (804) 963-0360

Inspection Date: Oct. 21, 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:

Standard Reviewed: 180-A Email fire inspection once completed to LI.

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: 10/21/2025 10:00 AM to 12:40 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: 13 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of participant records reviewed: 2 Number of staff records reviewed: 2 Number of interviews conducted with participants: 2 Number of interviews conducted with staff: 2 Observations by licensing inspector: Meals, Activities, and 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 #:	22VAC40-61-410-E
Description:	Based on direct observation and staff interview, the center failed to ensure cleaning supplies, pesticide, and all poisonous or harmful materials were stored in a locked place when not in use. Evidence: 1. During a tour of the facility, the LI observed the following items stored in unlocked areas of the center: a. Bleach and Fabuloso in the electrical closet off of the supply room b. Febreze room spray in the bathroom of the staff lounge c. A plug-in scent spray on the table of the sensory room/ space 2. In an interview with the LI on 10/21/2025, Staff 1 confirmed the cleaning supplies were not stored in a locked area of the center. 3. Photo evidence taken.
Plan of Correction:	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. Herndon ADHC will ensure that cleaning products are stored in locked areas. An action was taken on 10/21/2025, electrical closet door was closed, and staff will ensure that the door remains closed will check throughout the day. Febreze room spray has been removed and stored in the closet. Staff will ensure that plug-in scent sprays are plugged-in instead of loosely laying around. Daily walk through will be done to ensure compliance.
Standard #:	22VAC40-61-520-C
Description:	Based on facility document review and staff interview, the center failed to ensure a semi-annual review of the emergency preparedness and response plan was implemented for all staff, participants, and volunteers. Evidence: 1. After a review of the semi-annual review for staff, the LI requested a copy of the participant review of the emergency preparedness plan. Staff 1 stated that the review was not currently completed with participants, only staff members.
Plan of Correction:	The center will ensure a semi-annual review of the emergency preparedness and response plan will be implemented for all staff, participants, and volunteers. Herndon ADHC reviewed the emergency preparedness and response plan with participants on 10/22/2025 and 10/23/2025. Moving forward, emergency preparedness and response plan will be reviewed with participants upon admission and semi-annually. Proof of review will be filed in participants charts.