VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Sunrise Assisted Living at Reston Town Center
1778 Fountain Drive
Reston, VA 20190
(703) 956-8930

Current Inspector: Jacquelyn Kabiri (703) 397-3017

Inspection Date: Jan. 25, 2019 , Feb. 6, 2019 , Feb. 7, 2019 , Feb. 13, 2019 , Feb. 19, 2019 , March 6, 2019 and March 8, 2019

Complaint Related: No

Areas Reviewed:

22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES 22VAC40-73 STAFFING AND SUPERVISION 22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-73 BUILDING AND GROUNDS 22VAC40-73 EMERGENCY PREPAREDNESS

Comments:

Unannounced inspections were conducted in response to a facility-reported incident. Building and grounds were inspected. Interviews were conducted, facility documents were reviewed and records were observed. Violations were discussed and an exit meeting was held. Areas of non-compliance are identified on the violation notice. Please complete the 'plan of correction' and 'date to be corrected' for each violation cited on the violation notice and return to the licensing office within 10 calendar days. Please specify how the deficient practice will be or has been corrected. Just writing the word 'corrected' is not acceptable. The 'plan of correction' must contain: 1) Steps to correct the non-compliance with the standards, 2) Measures to prevent the non-compliance from occurring again, and 3) Person responsible for implementing each step and/or monitoring any preventative measures. Thank you for your cooperation and if you have any questions, contact me via e-mail at m.massenberg@dss.virginia.gov.

Violations:

Standard #:	22VAC40-73-40-A
Description:	Based on documentation, the licensee failed to ensure compliance with the facility's own policies and procedures. Evidence: Resident #1's occupational therapist attempted to locate the resident, after the therapist arrived at 1:00 PM on 1/21/19. The therapist informed facility staff about her inability to find Resident #1 at approximately 1:30 PM. According to progress notes, Resident #1 was unable to be found by a wellness nurse at approximately 2:45 PM and a search was then initiated. The facility?s elopement and missing resident policy (effective 7/9/18) states that no more than 30 minutes should lapse, between the time the search for the missing resident commences and a call to the local law enforcement authority. The Fairfax County Police Department was not contacted until 3:37 PM.
Plan of Correction:	The Resident Care Director initiated search protocols; and notified the police, resident?s responsible party, and the executive director that the community was searching for the resident. Police responded to the community and participated in the search that was already underway. The Executive Director and Care Coordinators conducted four emergency (missing resident) practice drills for the staff on the 3 shifts. Included in the drills and training, was and continues to be, timely notification to law enforcement within the 30 minute timeframe. The 30 minute timeframe was reinforced by the ED, Care Coordinators, and/or Maintenance Coordinator (MC), and was practiced during the drills. The Executive Director and/or designee continue to conduct unannounced missing resident drills, including evaluating drill response, and conducting ?in the moment? refresher training as needed. The drill evaluation includes assessing the 30 minute notification timeline and reinforcing the requirement to do so. The drill evaluation will be presented by the MC or Care Coordinator to the Quality Assurance and Performance Improvement committee for 3 months. During and at the end of the 3 months, the Quality Assurance and Performance Improvement (QAPI) committee will evaluate the results of the emergency and missing resident drills and evaluations to determine if additional focus or action is warranted. The Executive Director or designated coordinator is responsible for implementation and ongoing compliance with the components of this Plan of Correction and addressing and resolving variances that may occur.
Standard #:	22VAC40-73-450-H
Description:	Based on documentation and interview, the facility failed to ensure that care and services specified in the individualized service plan (ISP) are provided to each resident. Evidence: The ISP for Resident #1, revised 1/8/19, states that the resident needs 1 person physical assistance to the bathroom and that the assistance will be provided by a care manager. On 1/21/19, Staff #1 was the assigned care manager for Resident #1, during the 7:00 AM until 3:00 PM shift. The ISP also states that Resident #1 will be assisted to the bathroom "before and after meals, morning afternoon, and before bedtime." Lunch is served at noon. Staff #1 reported that she did not know that Resident #1 was missing until after 2:30 PM. Staff #1 reported seeing Resident #1 in the morning, but denied seeing the resident in the afternoon. No documentation was provided to indicate that facility staff attempted to assist Resident #1 to the bathroom after lunch.
Plan of Correction:	Resident #1: the Individual Service Plan (ISP) was reviewed by the Interdisciplinary Team following the event. The Interdisciplinary Team reviewed ISPs and point of care delivery information on current residents to confirm care and services are being delivered in accordance with resident preferences, resident needs, levels of assistance required, and physician orders; and that the ISPs are accurate and current. This review included a focus on care manager assistance with toileting and continence care. As part of the review, the Interdisciplinary Team conferred with care managers, med techs, and nurses who have working knowledge of the residents; and incorporated their feedback into the review and ISP update process. In addition, the Interdisciplinary Team conferred with residents and their responsible parties if there were areas that needed to be clarified. During the review, the Interdisciplinary Team updated ISPs, resolved focus areas no longer applicable, and added or supplemented individualized interventions. The Interdisciplinary Team (IDT) is continuing the process of reviewing residents who experience a change in condition ? cognitive, behavioral, medical, or functional status; or a change in preferences, or a change in physician orders, or who are exhibiting exit seeking or elopement behaviors at IDT Meetings, including a point of care delivery review. The meetings occur 2 to 3 times per month or as needed. ISP updates and individualized interventions are entered into the ISPs by the Resident Care Director or Care Coordinators. These updates and corresponding guidance for the care managers are communicated by the Coordinators to the care team via daily communication venues and shift to shift meetings. The results of the IDT Meetings will be presented to the Quality Assurance and Performance Improvement (QAPI) committee for 3 months by the RCD or Care Coordinator. During and at the end of the 3 months, the Quality Assurance and Performance Improvement (QAPI) committee will evaluate the results of the IDT meetings and determine if additional focus or action is warranted, or if the review period should be extended. The Executive Director or designated coordinator is responsible for implementation and ongoing compliance with the components of this Plan of Correction and addressing and resolving variances that may occur.
Standard #:	22VAC40-73-460-D
Description:	Based on documentation and interviews, the facility failed to provide supervision of resident schedules, care, and activities, including attention to specialized needs, such as prevention of falls and wandering from the premises. Evidence: Resident #1 was admitted to the facility in January 2017. Her physical examination, dated 1/3/17, documented the resident as having mild cognitive decline. Psychiatric notes from September 2018 indicate the resident?s increased confusion. The most recent psychiatric note, dated 1/7/19, states that the Resident #1 will wander, she is able to be redirected and that she is not noted to have gone out of the building or into the stairs. The individualized service plan (ISP) for Resident #1, revised 1/8/19, states that the resident has impaired recall and she is unable to remember place, event and date. The ISP also states that Resident #1 is at risk for a potential fall. Resident #1 eloped from the facility on 1/21/19. Law Enforcement found Resident #1 behind the facility, between a rear wall and a fenced garbage dumpster, at approximately 4:00 PM. Prior to the elopement, facility staff reported that Resident #1 was last seen at lunch around noon. Resident #1?s occupational therapist signed into the facility?s professional visitor log at 1:00 PM. The therapist reported that she looked around the facility for Resident #1 and spoke with several staff members about her attempts to locate the resident at approximately 1:30 PM. Before leaving the facility, the therapist informed Staff #2, 3, and 4, that she was not able to locate Resident #1. No supervisory staff members reported that they received this information from Staff #2, 3, or 4. Progress notes indicate that Resident #1 was not documented as missing until approximately 2:45 PM, when a wellness nurse was unable to find the resident. The wellness nurse reportedly wanted to follow-up with Resident #1, after she was heard screaming for help and unable to stand up by herself on 1/20/19. Law enforcement was contacted at 3:37 PM and they began searching around the facility when they arrived. Resident #1 was located at approximately 4:00 PM and she was taken to the Reston Hospital Center, where later that day she would pass away. According to weatherunderground.com, there was no precipitation and the temperature was between 17 and 21 degrees Fahrenheit, from noon until 4:00 PM on 1/21/19. Before her elopement, the last reported sighting of Resident #1 was around noon. Resident #1 was listed as one of the residents assigned to Staff #1, a care manager, on the 7 AM - 3 PM shift. The job description, for Staff #1, states that the care manager is responsible for a designated group of residents, knowing where their residents are and physically checking on them throughout the shift. Staff #1 reported that she checked on Resident #1 that morning, but she was unaware that the resident was missing until another staff member informed her about the wellness nurse being unable to find Resident #1 that afternoon.
Plan of Correction:	The Interdisciplinary Team (IDT) initially reviewed residents who were at risk for potential exit seeking and/or elopement behaviors and confirmed that their Individualized Service Plans (ISPs) included individualized strategies and interventions to address exit seeking and/or elopement behaviors. ISP revisions and supplements were made by the Resident Care Director or Care Coordinators as needed, and additional guidance for the care managers was communicated by the Coordinators to the care team via daily communication venues and shift to shift crossover meetings. Care Managers and Care Coordinators received refresher training conducted by the Executive Director and Resident Care Director regarding the process for care managers accessing and initiating tasks (the provision of care, services, and oversight for residents); which is located in the electronic medical record required for each resident. The Interdisciplinary Team (IDT) initially reviewed residents who were at risk for potential exit seeking and/or elopement behaviors and confirmed that their Individualized Service Plans (ISPs) included individualized strategies and interventions to address exit seeking and/or elopement behaviors. ISP revisions and supplements were made by the Resident Care Director or Care Coordinators as needed, and additional guidance for the care managers was communicated by the Coordinators to the care team via daily communication venues and shift to shift crossover meetings. Care Managers and Care Coordinators received refresher training conducted by the Executive Director and Resident Care Director regarding the process for care managers accessing and initiating tasks (the provision of care, services, and oversight for residents); which is located in the electronic medical record required for each resident. The Interdisciplinary Team (IDT) continues the process of reviewing residents who experience a change in condition ? cognitive, behavioral, medical, or functional status that may impact behaviors, or who are demonstrating exit seeking and/or elopement behaviors at IDT Meetings. The IDT meetings occur 2 to 3 times per month or as needed. ISP revisions or supplements are made by the Resident Care Director or Care Coordinators, and additional guidance for the care managers is communicated by the Coordinators to the care team via daily communication venues and shift to shift crossover meetings. Residents? primary care physicians and mental health professionals are contacted as appropriate for additional guidance, to discuss potential medication changes, and to confer regarding additional non-medicinal approaches. Care Managers continue to receive refresher training conducted by the Care Coordinators, Resident Care Director and/or Executive Director regarding resident assignments (care, services, and oversight required for residents) located in the electronic medical record for each resident. During and at the end of the 3 months, the Quality Assurance and Performance Improvement (QAPI) committee will evaluate the results of the IDT meetings, with a focus on resident care plan interventions and observations, and determine if additional focus or action is warranted, or if the review period should be extended. The Executive Director or designated coordinator is responsible for implementation and ongoing compliance with the components of this Plan of Correction and addressing and resolving variances that may occur.
Standard #:	22VAC40-73-990-B
Description:	Based on documentation and interviews, the facility failed to ensure that the procedures, in the plan for resident emergencies, are reviewed by the facility at least every six months with all staff. Evidence: 23 care managers were listed on the schedule for 1/21/19. In addition to the care managers, several supervisors and other facility staff members were present on 1/21/19. The most recent review, of the procedures for resident emergencies, was conducted on 12/13/18. No documentation was provided to confirm that the emergency procedures had been reviewed, within the past six months, for 19 out of 26 staff members (Staff #1, 4-21).
Plan of Correction:	The Executive Director and Maintenance Coordinator (MC) conducted training for the team members regarding emergency procedures that included handling medical emergencies, handling mental health emergencies, making pertinent medical information available, procedures to be followed in the event a resident is missing, notification procedures including the 30 minute timeframe. The training was completed on 1/28/19. The community conducted a Missing Resident Drill on 1/28/19 and conducted an additional emergency drill on 1/30/19 to confirm staff understanding of emergency procedures and their specific responsibilities. The Business Office Coordinator (BOC) conducted an audit of the training binder to confirm team members participated in the emergency training within the 6 month requirement. Issues identified were resolved. A resident emergency procedure training and drill calendar has been developed by the MC and ED that includes dates for every 6 month training and unannounced dates for drills. The BOC or designee will conduct a monthly audit for 6 months to confirm team member participation in emergency procedure training at a minimum of every 6 months. The results of the audit will be presented to the Quality Assurance and Performance Improvement (QAPI) committee by the BOC or designee. During and at the end of the 6 months, the Quality Assurance and Performance Improvement (QAPI) committee will evaluate the results of the emergency drill training and emergency drills and determine if additional focus or action is warranted, or if the review period should be extended. The Executive Director or designated coordinator is responsible for implementation and ongoing compliance with the components of this Plan of Correction and addressing and resolving variances that may occur.