VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Home Eldercare
10704 Orchard Street
Fairfax, VA 22030
(703) 273-3640

Current Inspector: Sarah Pearson (540) 680-9469

Inspection Date: Sept. 18, 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 22VAC40-80 THE LICENSE.

Comments:

An unannounced renewal study was conducted on 9/18/19. At the time of entrance 7 residents were in care. The sample size consisted of four resident records, and three staff records. Resident and staff records and other documentation were reviewed. Criminal Background Checks of all staff hired since the previous inspection conducted on 9/11/18 were reviewed. Residents were observed eating breakfast and engaging in activities including ball toss. Medications were reviewed and a walk of the physical plant was completed. Possible violations were discussed at the exit interview. 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 #:	22VAC40-73-430-H-2
Description:	Based upon a review of records, the facility failed to ensure that a copy of the written statement of discharge shall be retained in the resident's record. Evidence: Resident #4 was discharged on 9/6/19. The discharge notice form was not retained in the resident's record.
Plan of Correction:	The facility will make sure that each of the resident's file has the form for discharge and will fill it out at the time of discharge.
Standard #:	22VAC40-73-450-C
Description:	Based upon a review of resident records, the facility failed to ensure that the comprehensive service plan shall include the following: a description of identified needs based upon the UAI. Evidence: For Resident #1, the Uniform Assessment Instrument (UAI) completed on 12/10/18 indicated that the resident required mechanical and human help with bathing, dressing, and toileting. The Individualized Service Plan (ISP) dated 12/10/18 did not include the need for mechanical assistance with bathing, dressing, and toileting.
Plan of Correction:	Resident's service plan is corrected, the human and mechanical help are addressed. In future the needs will be addressed. The staff will help the resident with bathing, dressing, and toileting. The resident will sit on the shower chair while bathing and uses the walker at times as well as grab bars.
Standard #:	22VAC40-73-680-H
Description:	Based upon a review of medication administration records (MAR), interview with staff, and observation of the medications in the bubble pack, the facility failed to ensure that at the time the medication is administered, the facility shall document on the MAR all medications administered to residents, including over-the-counter medications and dietary supplements. Evidence: The MAR for Resident #2 indicated she was given Acetaminophen 325mg as needed (PRN) for pain at 8am, 2pm, and 8pm for the following days: September 1, 2019 through September 18, 2019. The staff person who administers the medications reported she did not administer those doses. A physical count of the medication verified that the medication had not been administered.
Plan of Correction:	All PRN medications will be high lighted to know that it is a PRN medication, so that error will not happen again.