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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 13, 2017

Complaint Related: No

Areas Reviewed:
63.2-1805-A The board shall adopt regulations:
22VAC40-72 GENERAL PROVISIONS
22VAC40-72 ADMINISTRATION AND ADMINISTRATIVE SERVICES.
63.2-1805-A-9 Requiring that each assisted living facility prepare and provide a statement, in a format prescribed by the Board, to any resident or prospective resident and his legal representative, if any, and upon request, that discloses whether the assisted living facility maintains liability insurance in force to compensate residents or other individuals for injuries and losses from the negligent acts of the facility, provided that no facility shall state that liability insurance is in place unless such insurance provides a minimum amount of coverage as established by the Board; and
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.

Comments:
An unannounced follow up inspection was conducted on 3/13/17. At the time of entrance six residents were in care with two staff present. The sample size consisted of four resident records, four staff records and one individual interview.. Resident and staff records and other documentation reviewed. Criminal Background Checks of all staff hired were reviewed. Residents were observed eating breakfast and engaging in activities including relaxing in their rooms and visiting with family. 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 #: 22VAC40-72-290-C
Description: Facility failed to ensure that all personal and social data to be maintained on staff shall be included in the staff record. 1/4 staff records did not include documentation of two references. Staff #2 hired on 2/16/2017 does not have documented references.

Plan of Correction: Owner/Administrator will document references.

Standard #: 22VAC40-72-290-D-1-a
Description: Facility failed to ensure that each staff person on or within seven days prior to the first day of work at the facility and each household member prior to coming in contact with residents shall submit the results of a risk assessment, documenting the absence of tuberculosis in a communicable form as evidenced by the completion of the current screening form published by the Virginia Department of Health or a form consistent with it. 1/4 staff records did not include a TB screening. Staff #2 hired on 2/6/17 did not have a documented TB screening.

Plan of Correction: Owner/Administrator will get documentation of TB screening.

Standard #: 22VAC40-72-300-C
Description: Facility failed to ensure that each direct care staff member shall receive certification in first aid from an organization listed in subsection A of this section and maintain current certification in first aid as specified in subsection A of this section, unless the direct care staff member is a registered nurse or licensed practical nurse. 1/4 staff records did not have documentation of First Aid Training. Staff #1 hired as a direct care staff member on 1/30/17 does not have documentation of First Aid Training.

Plan of Correction: Owner/Administrator will schedule the training.

Standard #: 22VAC40-72-670-C
Description: Facility failed to ensure that all medications shall be administered in accordance with the physician's or other prescriber's instructions and consistent with the standards of practice outlined in the current registered medication aide curriculum approved by the Virginia Board of Nursing. Resident #1 has a physician's order for 5mg Finasteride once a day. This medication was not available for administration.

Plan of Correction: The facility had contacted the family who is responsible for medication refills however the pharmacy made an error in filling the medication thus delivery has been delayed.

Standard #: 22VAC40-72-670-H
Description: Facility failed to document on a medication administration record (MAR) all medications administered to residents, including over-the-counter medications, and dietary supplements.

The MAR was not signed for the entire day of 3/11/17.

Plan of Correction: Owner/Administrator to retrain staff to ensure the MAR is signed when medications are administered.

Standard #: 22VAC40-72-690-2
Description: Facility failed to ensure that "No Smoking-Oxygen in Use" signs are posted in any room where oxygen is in use. Resident #4 uses Oxygen PRN and has portable oxygen tanks in a closet outside of her room. There is not a No Smoking sign posted.

Plan of Correction: Owner/Administrator to contact hospice to obtain a "No Smoking-Oxygen in Use" sign.

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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