VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Avalon House on High Street
6712 High Street
Falls church, VA 22046
(703) 532-6303

Current Inspector: Sarah Pearson (540) 680-9469

Inspection Date: July 15, 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 32.1 Reported by persons other than physicians 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

Comments:

An unannounced monitoring inspection was conducted on 7/15/19. At the time of entrance seven residents were in care. The sample size consisted of four resident records and three staff records. There have been no new hires since the last mandated inspections. Additionally, individual interviews were conducted. Residents were observed eating breakfast and engaging in activities. Medication were reviewed. Violation notice issued with the assessed risk reviewed and exit interview held with Administrator. Thank you for your cooperation and if you have any questions please e-mail tammy.pruitt@dss.virginia.gov or call 703-314-0604.

Violations:

Standard #:	22VAC40-73-250-D
Description:	Based on documentation review, the facilility failed to ensure: Health information required by these standards shall be maintained at the facility and be included in the staff record for each staff person, and also shall be maintained at the facility for each household member who comes in contact with residents. Each staff person or household member required to be evaluated shall annually submit the results of a risk assessment, documenting that the individual is free 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. As evidenced by: Paper work in staff member #3's record shows the last evaluation for tuberculosis was conducted on 4/5/17 making it more than a year old.
Plan of Correction:	Facility Administrator will check to see if the paperwork for resident #3 has inadvertently been kept at the corporate office. If not, a TB screening will be will be conducted as soon as possible.
Standard #:	22VAC40-73-660-A-6
Description:	Based on observation, facility failed to ensure refrigerated medications were locked. As evidenced by: The downstairs refrigerator was left unlocked with a box full of Influenza vaccine injection shots. The shots were assessable to resident living downstairs as well as any other resident capable of doing the stairs.
Plan of Correction:	The shots were immediately locked.