VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Heritage Village Assisted Living and Memory Care
13650 Heathcote Boulevard
Gainesville, VA 20155
(703) 468-1895

Current Inspector: Sarah Pearson (540) 680-9469

Inspection Date: Aug. 21, 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 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

Comments:

Date of Inspection: August 21, 2019; 9am to 2pm Type of Inspection: Renewal Inspection Census 108 Number of records reviewed and interviews conducted-10 resident records, 9 employee records, 11 interviews. 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. All previous self-reported incidents were reviewed at this time

Violations:

Standard #:	22VAC40-73-450-F
Description:	Based on chart review and interviews, it was determined the facility did not update the individualized service plans as needed as the condition of the resident changes. Findings: Resident's B and C did not have the wound care specified on the ISP.
Plan of Correction:	Resident's B and C ISP will be reviewed and updated as needed. In addition, all residents with wounds ISP will be reviewed and updated as needed.
Standard #:	22VAC40-73-750-B
Description:	Based on observation and interviews it was determined the facility did not maintain all beds with springs. Evidence: Resident A's bed was equipped with Halos and did not have springs.
Plan of Correction:	Resident A bed will be evaluated and new bed will be implemented to include springs. All beds in facility will be reviewed and addressed as needed to include updating ISP's.