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: June 4, 2019

Complaint Related: No

Areas Reviewed:

22VAC40-73 GENERAL PROVISIONS 22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES 22VAC40-73 PERSONNEL 22VAC40-73 STAFFING AND SUPERVISION 22VAC40-73 ADMISSION, RETENTION, AND DISCHARGE OF RESIDENTS 22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-73 RESIDENT ACCOMODATIONS AND RELATED PROVISIONS 22VAC40-73 BUILDING AND GROUNDS 22VAC40-73 EMERGENCY PREPAREDNESS 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS Article 1 Subjectivity 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.

Comments:

An unannounced renewal inspection was conducted on 6/4/19 (8:15 AM - 5:45 PM). At the time of entrance, 82 residents were in care. Meals, medication administration and activities were observed. Building and grounds were inspected. Interviews were conducted and records were reviewed. The sample size consisted of 10 resident records and five staff records. 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, please contact me via e-mail at m.massenberg@dss.virginia.gov.

Violations:

Standard #:	22VAC40-73-450-C
Description:	Based on record review, the facility failed to ensure that the individualized service plan (ISP) is based upon the uniform assessment instrument (UAI). Evidence: The UAI for Resident #5, dated 5/15/19, states that the resident needs only physical assistance for bathing. The ISP for Resident #5, dated 5/16/19, indicates that the resident needs physical and mechanical assistance for bathing. The UAI for Resident #10, dated 12/13/18, states that the resident needs supervision and mechanical assistance for walking. The ISP for Resident #10, dated 12/19/18, indicates that the resident needs physical assistance and mechanical assistance for walking.
Plan of Correction:	The Resident Care Coordinator reviewed and updated the ISPs and UAIs for residents #5, #10 to include required physical and mechanical assistance for bathing and mechanical and physical assistance for walking. RCD and ED conducted refresher training for the Assisted Living Coordinator and Reminiscence Coordinator regarding process for updating ISPs and UAIs, and confirming they are current regarding required physical and mechanical assistance for bathing and mechanical and physical assistance for walking. The ALC and RC conducted an audit of residents' UAIs and ISPs to confirm the current status of the physical and mechanical assistance for bathing, and mechanical and physical required is reflected in the UAIs and ISPs. Issues identified were addressed and resolved. The Assisted Living Coordinator (ALC), Resident Care Director (RCD), Reminiscence Coordinator (RC) or designee will conduct audits of residents' UAIs and ISPs monthly for 3 months to confirm the current status of the physical and mechanical assistance for bathing, and mechanical and physical assistance for walking required by the residents is reflected in the UAIs and ISPs. During and at the end of the 3 months, the QAPI committee will evaluate the results of the ISP and UAI audits and 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 #:	22VAC40-73-680-D
Description:	Based on observation and documentation, the facility failed to ensure that medications are administered in accordance with the physician's instructions. Evidence: The morning medication administration, for Resident #11, was observed during the inspection. Resident #11's medications were removed from their packages and placed into a pill cup. Several tablets, from the pill cup, were then placed into a pill pouch to be crushed. Before the tablets were crushed, the licensing inspector asked about Resident #11's Primidone. Resident #11's medication administration record (MAR), called for the resident to receive two tablets of Primidone. Only one Primidone tablet had been removed from the medication package.
Plan of Correction:	Resident #11 was administered the Primidone tablets per physician order within the correct timeframe during the survey. The Medication Care Manager refresher training regarding conducting a triple check of EMARs to medications prior to administration to confirm appropriate dosage, by the Resident Care Director (RCD). The resident experienced no negative outcomes as a result of the medication administration. RCD or Wellness Nurse conducted random medication pass observations of Medication Care Managers to confirm that medications were administered in accordance with physician orders - including appropriate dosage. No issues were identified. Resident Care Director (RCD) will conduct refresher training with Medication Care Managers on confirming medications are administered in accordance with physician orders, including the process for obtaining order clarification, as/if needed. The refresher training includes: the process for Medication Care Managers reviewing both the EMARs and the dosage on the labeling of the medication package to confirm accurate dosage according to physician orders, prior to administration. The RCD or Wellness Nurse will conduct med pass observations monthly for 3 months to confirm medication administration is being performed in accordance with physician orders, with a focus on dosage administration. The RCD or Wellness Nurse will present and review the results of the observations to the Quality Assurance and Performance Improvement (QAPI) committee. During and at the end of the 3 months, the Quality Assurance and Performance Improvement (QAPI) committee will evaluate the results of the medication pass observations and 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 #:	22VAC40-73-680-M
Description:	Based on observation and interview, the facility failed to ensure that PRN medications are available and properly stored at the facility. Evidence: PRN Loperamide, ordered for Resident #12, was not present at the time of the medication cart inspection. Facility staff confirmed that the medication was not present, at the time of the medication cart inspection.
Plan of Correction:	The Resident Care Director obtained the PRN medication for Resident #12 and placed the medications in the med cart; and communicated the arrival and the placement of the medication to the LPN Medication Care Managers. Resident Care Director has completed an EMAR to cart audit to confirm PRN medications were present per physician orders. No issues were identified. The Resident Care Director or designee will conduct refresher training with the nurses regarding medication ordering procedures and the processes to confirm availability of PRN medications in carts. Resident Care Director or designee will conduct weekly audits for one month and monthly audits for 2 months of medication carts to EMARs to confirm availability of PRN medications in medication carts; and will report the findings at the QAPI meetings. Issues identified will be addressed and resolved by the RCD and refresher training initiated as needed. During and at the end of the 3 months, the QAPI committee will evaluate the results of the medication cart audits and 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 #:	22VAC40-73-720-A
Description:	Based on record review, the facility failed to ensure that the procedures for Do Not Resuscitate (DNR) Orders are followed. Evidence: The DNR for Resident #10, dated 12/3/18, was not included in the resident's ISP. The ISP, dated 12/19/18, lists Resident #10 as being full code.
Plan of Correction:	The ISP for Resident #10 was updated by the Resident Care Director (RCD) to include accurate Advance Directive/ISP information. The RCD and Assisted Living Coordinator (ALC) conducted an audit of resident ISPs and in compliance with the documents provided by the resident and/or responsible party. Issues identified were addressed and resolved. During ISP care conferences, the Care Coordinators or Resident Care Director will confirm with the residents and/or their responsible parties that the Advance Directives/DNRs are in compliance with the documents provided by the residents and/or their responsible parties; and are reflected in the ISPs. The Resident Care Director or designee will audit ISPs monthly for 3 months to confirm that Advance Directive/DNRs are in compliance with the documents provided by the residents and/or their responsible parties; and are reflected in the ISPs. The Resident Care Director or designee will audit ISPs monthly for 3 months to confirm that Advance Directive/DNRs are included in the ISPs. During and at the end of the 3 months, the QAPI committee will evaluate the results of the ISP audits and 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.