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: July 2, 2019 and July 3, 2019

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 PERSONNEL 22VAC40-73 STAFFING AND SUPERVISION 22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS Article 1 Subjectivity

Comments:

Licensing Inspector (LI) conducted unannounced complaint investigation on 7/2/19, 7/3/19 regarding staffing quantity, staffing quality, and response time for medical care following a resident's fall. LI reviewed resident records, medication administration records, staff medication aide certification, staff records, and progress notes for residents. LI interviewed staff and residents. LI spoke with Executive Director and Director of Nursing. Complaint regarding Standard 1130 A is deemed valid as a preponderance of evidence gathered during the investigation supported the allegation. A violation of Standard 290-A-1 was also cited but it was not related to the complaint. Exit interview conducted on 7/3/19 and the administrator signed the acknowledgement of inspection. 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 email at jamie.eddy@dss.virginia.gov.

Violations:

Standard #:	22VAC40-73-1130-A
Complaint related:	Yes
Description:	Based upon a review of facility records and interview with administration, the facility failed to ensure that when 20 or fewer residents are present, at least two direct care staff members shall be awake and on duty at all times in each special care unit who shall be responsible for the care and supervision of the residents. For every additional 10 residents, or portion thereof, at least one more direct care staff member shall be awake and on duty in the unit. Evidence: On the following days only three direct care staff were listed on the schedule to work on the memory care unit during the night shift (11pm to 7am): June 9th, June 13th, June 22nd, June 23rd, June 27th, and June 30th. The number of residents present on the memory care unit on those days would require that four direct care staff members be awake and on duty in the unit.
Plan of Correction:	Scheduling will include a total of four direct care staff for a census greater than 30 residents on night shift. This will be reflected on the schedule beginning July 7, 2019. Hiring and onboarding of staff is ongoing. A minimum of two care staff will be provided for 20 or less residents. For each additional 10 residents, or a portion thereof, an additional care staff will be provided. Care staff is to be present and awake during care hours. Scheduling is to be arranged by the MC/Staffing coordinator and overseen by the VP Resident Experience.
Standard #:	22VAC40-73-290-A
Complaint related:	No
Description:	Based upon a review of facility records and interview with administration the facility failed to maintain an accurate written work schedule that included any absences, substitutions, or other changes. Evidence: The work schedule for June 2019 did not include all of the changes or substitutions that occurred for the night shift (11pm to 7am).
Plan of Correction:	Master schedule book to be kept in the Memory Care (MC) Coordinator's office and schedule posted throughout med rooms with schedule changes to include names of employees and shift changes/substitutions beginning July 7, 2019. Schedule book to be maintained by the MC Coordinator/Scheduler and posted as needed. This task is ongoing.