VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Westminster At Lake Ridge
12185 Clipper Drive
Lake ridge, VA 22192-2236
(703) 496-3400

Current Inspector: Sarah Pearson (540) 680-9469

Inspection Date: July 16, 2019

Complaint Related: No

Areas Reviewed:

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 BUILDING AND GROUNDS 22VAC40-73 EMERGENCY PREPAREDNESS 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS Article 1 Subjectivity

Technical Assistance:

The next Phase 2 training in our region will be September 3, 2019. To register call 540-347-6345. The new manager will be required to attend this training.

Comments:

Date of Inspection: July 2 and 12, 2019 Type of Inspection: Renewal Inspection 9am to 330pm If you have any questions or email changes, please do not hesitate to contact me at ken.koontz@dss.virginia.gov. If you need a copy of any of the DSS Model forms or to review any inspection or regulation, you can find the information on the internet: www.dss.virginia.gov. Census 32 Number of records reviewed and interviews conducted-7 resident records, 3 employee records, 8 interviews. All facility self-reported incidents since the last inspection were reviewed on this date. The Licensing Inspector and the Administrator discussed the risk assessment ratings for the violation(s) for this inspection. Please complete the ?plan of correction? and ?date to be corrected? for each violation cited on the violation notice and returned it to the office. You will need to specify how the deficient practice will be or has been corrected. Your plan of correction must contain: 1) steps to correct the noncompliance with the standard(s), 2) measures to prevent the noncompliance from occurring again; and 3) person(s) responsible for implementing each step and/or monitoring any preventive measure(s). The Licensing Inspector will attend the facility on July 23, 2019 for the completed corrective action

Violations:

Standard #:	22VAC40-73-50-B
Description:	Based on observations, interviews and chart review, it was determined the facility failed to maintain a written acknowledgment of the receipt of the disclosure that contained liability insurance information by the resident or his legal representative in the resident's record. Evidence: Two of the two records reviewed for compliance with this standard did not contain verification of the receipt of the disclosure statement. The disclosure statement could not be located at the time of the inspection.
Plan of Correction:	Center will update disclosure statement to include verbiage on liability insurance. Center will obtain disclosure statements for all residents found to be without it, center will obtain copy from resident or resident representative
Standard #:	22VAC40-73-70-C
Description:	Based on observations, interviews and chart review, it was determined the facility failed to submit a written report of each incident to the regional licensing office within seven days from the date of the incident. The report shall be signed and dated by the administrator. Evidence: The facility verbally contacted the LI with a notification that the air conditioning was inoperable on June 27, 2019. The air temperature on that date exceeded 80 degrees. No written report was submitted.
Plan of Correction:	center to provide written notification to licensing inspector for power outages, planned and unplanned.
Standard #:	22VAC40-73-220-A
Description:	Based on observations, interviews and chart review, it was determined the facility failed to obtain a written description of services when private duty personnel from licensed home care organizations provide direct care or companion services to residents in an assisted living facility Evidence: At the time of the inspection, the facility staff was not able to provide a written description of services with the licensed home health and hospice agency.
Plan of Correction:	center to obtain agreement from agency for cited private duty personnel. Center to obtain agreement from hiring agencies for private duty personnel
Standard #:	22VAC40-73-490-A-3
Description:	Based on record review and interviews it was determined the facility did not ensure all residents were included at least annually in health care oversight. Evidence: A review of the healthcare oversight determined the facility was not documenting which residents were being reviewed.
Plan of Correction:	center to obtain updated forms. Center to ensure health care oversight meeting occurs at minimum every 6 months and ensure all residents are reviewed
Standard #:	22VAC40-73-970-A
Description:	Based on observations, interviews and chart review, it was determined the facility failed to conduct fire and emergency evacuation drill in accordance with the current edition of the Virginia Statewide Fire Prevention Code (13VAC5-51). Evidence: Recordation provided verified no fire drills were conducted on April or May, 2019.
Plan of Correction:	center to ensure fire drills are conducted at least once monthly