VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Avalon House on Woodacre Drive
1505 Woodacre Drive
Mc lean, VA 22101
(301) 656-8823

Current Inspector: Jacquelyn Kabiri (703) 397-3017

Inspection Date: Sept. 26, 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 BUILDING AND GROUNDS 22VAC40-73 EMERGENCY PREPAREDNESS 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS Article 1 Subjectivity 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.

Technical Assistance:

Please ensure facility maintains an understanding of ambulatory and nonambulatory status to ensure compliance with building permit and licensing restrictions. ALF Disclosure Statement and Infection control plan under review for updates per standards.

Comments:

An unannounced monitoring study was conducted from 8:55a.m. - 3:00p.m. on 0/00/2019. At the time of entrance 7 residents were in care. The sample size consisted of eight residents and three staff. One family member and staff were interviewed. Resident and staff records and other documentation reviewed. Volunteers and pets were not identified by the facility. Criminal Background Checks of all staff hired since previous inspection conducted on 2/19/2019 were reviewed. Residents were observed eating breakfast and lunch and engaging in activities including ball toss and live music entertainment. Medication administration was observed with one staff and PRN medications were observed. Building and Grounds observed. Violations and risk ratings reviewed during exit interview with administrator. 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) 895-5627 or contact me via e-mail at jeannette.zaykowski@dss.virginia.gov.

Violations:

Standard #:	22VAC40-73-540-B
Description:	Based on documentation and interview, facility failed to ensure that visiting hours shall not be restricted, except by a resident when it is the resident's choice. Evidence: Resident Agreement notes "visiting hours are from 10am - 8:30pm daily".
Plan of Correction:	For any new resident who has moved into the home since the inspection, the visiting hours portion has been taken out of the agreement. For any resident that has had a recent contract renewal that has been signed and dated since the licensing inspection, the resident agreement sent to them had the visiting hours section taken out. The other families were notified via telephone of the visiting hours not being restricted and when it is time to renew their resident agreements that section will not appear in their agreements. Administrator has already taken that portion out of the resident agreement on their computer. Therefore, it should not appear in the agreements, in the future.
Standard #:	22VAC40-73-930-A
Description:	Based on observation and interview, facility failed to ensure that facility shall have a signaling device that is easily accessible to the resident in his bedroom or in a connecting bathroom that alerts the direct care staff that the resident needs assistance. Evidence: Resident rooms are not numbered and one resident room was observed with the call bell on the floor under the bed, and one resident room was observed with a call bell mounted to the bedroom wall in between the bed and the bathroom and was not easily accessible to the resident.
Plan of Correction:	Administrator & staff will check the home bi-weekly to ensure call bells are easily accessible to residents in their bedrooms. Staff will report any buzzer that is not in an easily accessible area to the administrator. A handy person will then be contacted to place one in an area that is accessible to the resident easily.
Standard #:	22VAC40-73-950-F
Description:	Based on documentation review and interview, facility failed to ensure that the facility shall review the emergency preparedness plan annually or more often as needed, document the review by signing and dating the plan, and make necessary plan revisions and such revisions shall be communicated to staff, residents, and volunteers and incorporated into the orientation and semi-annual review for staff, residents, and volunteers. Evidence: Documentation of an annual and semi-annual review of the emergency preparedness plan was not available and interview stated the review had not been done.
Plan of Correction:	Administrator spoke with the office that handles Emergency preparedness on October 16, 2019. The coordinator went over the company's plan and said at this time there were no updates or changes that needed to be made to it. They also said it was one of the better plans they have seen. The Administrator went over what was discussed with the Fairfax County Office of Emergency Management with the staff at the home. Documentation that the conversation took place has been placed in the proper location in the home. The administrator will keep documentation that these conversations occurred in the home after they happen and will do so with the frequency the regulations state. If they cannot reach the Fairfax County Office of Emergency in the future, documentation will be provided of the attempt. The staff have signed and dated a form that they read the plan after it was completed. That page is kept in the binder with the emergency plan