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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: March 7, 2016

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.
13.3 The Board of Nursing shall accept as evidence
32.1 Report by person other than physician
63.2 General Provisions.
63.2 Protection of adults and reporting.
63.2 Licensure and Registration Procedures
63.2 Facilities and Programs..
22VAC40-90 Background Checks for Assisted Living Facilities
22VAC40-90 The Sworn Statement or Affirmation
22VAC40-90 The Criminal History Record Report
22VAC40-80 THE LICENSE.
22VAC40-80 THE LICENSING PROCESS.
22VAC40-80 SANCTIONS.

Comments:
An unannounced renewal study was conducted on 3/7/16. At the time of entrance three residents were in care with one staff member present. The sample size consisted of three resident records and one individual interview. Resident records and other documentation reviewed. No new staff have been hired since the previous inspection. Residents were observed relaxing in their rooms. Medication administration was observed. 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-J
Description: Facility failed to ensure that the use of PRN (as needed) medications is prohibited, unless one or more of the following conditions exist: The physician's or other prescriber's instructions shall include symptoms that might indicate the use of the medication, exact dosage, the exact time frames the medication is to be given in a 24-hour period, and directions as to what to do if symptoms persist. Evidence: Resident #1's PRN order dated 3/5/16 for Lorazapam does not include exact time frames and Resident #1's order for protective ointment does not include exact name of the medication, dosage and time frames.

Plan of Correction: Owner to get corrected orders from Hospice today.

Standard #: 22VAC40-72-670-K
Description: Facility failed to ensure that medications ordered for PRN administration shall be available, properly labeled for the specific resident and properly stored at the facility. Evidence: Resident #1 has a PRN order for Acetaminophen and the medication was not available.

Plan of Correction: Medication to be delivered today.

Standard #: 22VAC40-72-840-I
Description: Facility failed to ensure that cleaning supplies and other hazardous materials shall be stored in a locked area. Evidence: Cleaning Supplies were observed unlocked in the storage room off of the kitchen.

Plan of Correction: Corrected during inspection - Owner/Administrator to ensure cleaning supplies remain locked.

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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