VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Golden Years and More
13114 Canova Drive
Manassas, VA 20112-7840
(703) 407-9492

Current Inspector: Sarah Pearson (540) 680-9469

Inspection Date: Nov. 13, 2019 and Nov. 15, 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: November 13 and 15, 2019; 9am to 1:30pm Type of Inspection: Renewal Census 6 5 resident charts reviewed, 2 staff charts reviewed and 5 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 The Licensing Inspector and the Administrator discussed the risk assessment ratings for the violation(s) for this inspection.

Violations:

Standard #:	22VAC40-73-1020-A
Description:	Based on observation and interviews, it was determined the facility failed to maintain at least two direct care staff members awake and on duty at all times in each building who shall be responsible for the care and supervision of the residents. VIOLATION The facility has three full time staff. This will not allow for scheduling of 2 staff awake and on duty at all times.
Plan of Correction:	Facility will be hiring 2 more staff members, Staff A (Caregiver) and Staff B (Caregiver in training) effective immediately.
Standard #:	22VAC40-73-325-A
Description:	Based on chart review, it was determined the facility failed to have the fall risk addressed on the comprehensive ISP VIOLATION Resident C and Resident A have fall risk documented on their fall risk assessment. The care need is not addressed on the ISP
Plan of Correction:	All residents will have a current fall assessment completed in their record. Any resident that had a documented fall risk, will have the care need addressed on the ISP
Standard #:	22VAC40-73-690-B
Description:	Based on chart review, it was determined the facility failed to obtain a medication review every six months of all the medications of the resident. VIOLATION Resident A does not have a current medication review or TB test. Resident had surgery on 8/14/19. The discharge summary required follow-up with a physician, the resident has not seen a physician. Resident B received a second degree burn from oatmeal falling onto her thigh. The Division of licensing was not notified of this event
Plan of Correction:	A review will be conducted to ensure all residents have a current TB test and medication review. Any incident that meets the requirements of 22 VAC 40-73-70 a will reported to DOLP in the future