VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Tribute at One Loudoun, LLC
20335 Savin Hill Drive
Ashburn, VA 20147
(571) 252-8292

Current Inspector: Laura Lunceford (540) 219-9264

Inspection Date: Nov. 21, 2019

Complaint Related: No

Areas Reviewed:

22VAC40-73 ADMISSION, RETENTION, AND DISCHARGE OF RESIDENTS 22VAC40-73 RESIDENT CARE AND RELATED SERVICES

Comments:

On 11/21/19 Licensing Inspector (LI) conducted unannounced inspection in response to self-reported incidents. Reviewed resident records and conducted resident and staff interviews. 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 email at jamie.eddy@dss.virginia.gov.

Violations:

Standard #:	22VAC40-73-320-A
Description:	Based upon a review of records, the facility failed to ensure that within the 30 days preceding admission, a person shall have a physical examination by an independent physician. The report of such examination shall be on file at the assisted living facility and shall contain the following: results of a risk assessment documenting the absence of tuberculosis in a communicable form as evidenced by the completion of the current screening form published by the Virginia Department of Health or a form consistent with it. Evidence: The record for Resident #2 did not include the results of TB assessment indicating absence of TB in a communicable form.
Plan of Correction:	Nurses, RMAs, Coordinator, and Community Relations Team were in-serviced on admission documents required to meet regulation. Absence of TB in a communicable form document to be included and kept on records. Implementation to be directed by Constance Moore. Monitoring to be directed by Constance Moore, nurse on duty, and nurse in charge. In service required admission documents with the admission team to be monitored by Constance Moore, nurse on duty, and nurse in charge.
Standard #:	22VAC40-73-640-A
Description:	Based upon a review of records and interviews with staff, the facility failed to implement the methods in the facility's medication plan to ensure that each resident's prescription medications ordered are filled and refilled in a timely manner to avoid missed dosages. Evidence: The November 2019 Medication Administration Record for Resident #2 indicated that on 11/19/19 at 8 am and 8 pm the schedule dosage of Hydrocod/APAP 7.5-325 TA was not given as the medication was not available. The 8 am dosage of Hydrocod/APAP 7.5-325 TA was not given on 11/20/19 as the medication was not available.
Plan of Correction:	Nurses and RMAs were in-serviced to notify contracted pharmacy to refill and deliver those medications that are 7 days or less in order to prevent missed doses. Implementation will be completed by Constance Moore. Monitoring to be directed by Constance Moore, nurse on duty, and nurse in charge. Nurses and RMAs to be in-serviced on the process of using the back up pharmacy. Pharmacy representative to be in-serviced. Constance Moore will direct the implementation.
Standard #:	22VAC40-73-680-D
Description:	Based upon a review of records and interviews with staff, the facility failed to ensure that medications shall be administered in accordance with the physician's or other prescriber's instructions and consistent with the standards of practice outlined in the current registered medication aide curriculum approved by the Virginia Board of Nursing. Evidence: Resident #3's prescribed order for Levothyroxine 150mcg to be taken once a day, was not administered on 11/1/19, 11/2/19, 11/4/19 and 11/5/19 as the medication was not in the medication cart. According to pharmacy records, an order of Levothyroxine for Resident #3 was delivered to the facility on 10/26/19 and the order contained 30 pills.
Plan of Correction:	Nurses and RMAs were in-serviced to transfer the new batch of monthly medications into the medication cart upon acceptance. Constance Moore will direct the implementation. Monitoring to be completed by Constance Moore, the nurse on duty, and nurse in charge. Should a prescribed medication noted to be missing, the Nurse/RMA will contact the pharmacy immediately for investigation and delivery. Constance Moore will direct implementation. Monitoring will be completed by Constance Moore, nurse on duty, and nurse in charge.