VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Tribute at One Loudoun, LLC
20335 Savin Hill Drive
Ashburn, VA 20147
(571) 252-8292

Current Inspector: Laura Lunceford (540) 219-9264

Inspection Date: May 23, 2019

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS Article 1 Subjectivity

Technical Assistance:

LI reviewed Standard 680-K-3 and reviewed all the information that is to be included on physician's or other prescriber's orders for Per Requested Need (PRN) medications.

Comments:

Licensing Inspector (LI) conducted unannounced complaint investigation on 5/23/19 regarding resident medication administration. LI reviewed residents records, medication administration records, and observed a medication pass. LI spoke with Executive Director and the Memory Care Director. Complaint regarding resident medication administration is deemed not valid as a preponderance of evidence gathered during the investigation did not support the allegations. A violation of Standard 1110-B was found and cited. 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 standard(s), 2) measures to prevent the non-compliance from occurring again; and 3) person(s) responsible for implementing each step and/or monitoring any preventative measure(s). Thank you for your cooperation and if you have any questions please call 703-479-5247 or contact me via e-mail at jamie.eddy@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-1110-B
Complaint related:	No
Description:	Based upon a review of resident records, the facility failed to ensure that six months after placement of the resident in the safe, secure environment and annually thereafter, the licensee, administrator, or designee shall perform a review of the appropriateness of each resident's continued residence in the special care unit. Evidence: Resident #2's initial approval for placement on the safe and secure unit was completed 4/19/18. No documentation of the six-month or annual review of the appropriateness of resident's continued residence in the special care unit was found. Resident #3's initial approval for placement on the safe and secure unit was completed 2/14/18. No documentation of the six-month or annual review of the appropriateness of resident's continued resident in the special care unit was found.
Plan of Correction:	Immediately completed the form to ensure the resident was appropriate for placement in the special care unit. Audited all special/memory care residents and checked for the six month and annual review of appropriateness for continued placement on the special care unit and updated as necessary (May 24, 2019). The facility will create a tickler system for new residents six month reviews and annual reviews to keep this updated.