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Purcellville Home Assisted Living Facility Inc.
16764 Hillsboro Road
Purcellville, VA 20132
(703) 336-9236

Current Inspector: Jamie Eddy (703) 479-5257

Inspection Date: Sept. 21, 2015

Complaint Related: No

Areas Reviewed:
22VAC40-72 GENERAL PROVISIONS
22VAC40-72 ADMINISTRATION AND ADMINISTRATIVE SERVICES.
22VAC40-72 PERSONNEL.
22VAC40-72 STAFFING AND SUPERVISION.
22VAC40-72 ADMISSION, RETENTION AND DISCHARGE OF RESIDENTS
22VAC40-72 RESIDENT CARE AND RELATED SERVICES
22VAC40-72 RESIDENT ACCOMMODATIONS AND RELATED PROVISIONS.
22VAC40-72 BUILDINGS AND GROUNDS.
22VAC40-72 EMERGENCY PREPAREDNESS.
22VAC40-72 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS WHO CANNOT RECOGNIZE DANGER OR PROTECT THEIR OWN SAFETY AND WELFARE.
Article1.
Subjectivity.

Technical Assistance:
Please submit documentation of an updated health inspection and building inspection. When that documentation is received by the licensing office the Conditional License will be issued.

Comments:
An announced initial inspection was conducted on 9/21/15. At the time of entrance two residents were in care with two staff people including the owner/administrator. The sample size consisted of two resident records, two staff records and one individual interview. Resident and staff records and other documentation reviewed. Residents were observed resting in their rooms and going out with friends. No medications were administered during the inspection. Medication cart was inspected. Violation notice issued, risk ratings reviewed and exit interview held. Thank you for your cooperation and if you have any questions please call 703-479-4708 or contact me via e-mail at lynette.storr@dss.virginia.gov.

Violations:
Standard #: 22VAC40-72-670-F
Description: Facility failed to ensure that over-the-counter medication shall remain in the original container, labeled with the resident's name, or in the pharmacy-issued container, until administered. Evidence: All of the over-the-counter medication in the med cart was not marked with the resident's name.

Plan of Correction: Owner/Administrator to label all over-the-counter medications.

Standard #: 22VAC40-72-670-H
Description: The facility failed to ensure that the facility shall document on a medication administration record (MAR) all medications administered to residents, including over-the-counter medications, and dietary supplements. For PRN medication the MAR shall include: symptoms for which medication was given and effectiveness. Evidence: Resident #1 takes PRN medication for pain. The MAR does not indicate the symptoms for which the medication was given and the effectiveness.

Plan of Correction: Resident routinely takes the pain medication and the facility is waiting for a standing order but will begin meeting requirements for the documentation of a PRN medication.

Disclaimer:
A compliance history is in no way a rating for a facility++.

The online compliance history includes only information after July 1, 2003. In addition, the online compliance history includes information regarding adverse actions that may be the subject of a pending appeal. An adverse action is not final until a provider has exhausted or waived all due process rights. For compliance history prior to July 1, 2003, or information regarding the status of pending adverse actions, please contact the Licensing Inspector listed in the facility's information. The Virginia Department of Social Services (VDSS) is not responsible for any errors in or omissions from the compliance history information.

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