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Vienna Manor IV, LLC
3903 Estel Road
Fairfax, VA 22031
(703) 218-1891

Current Inspector: Marshall G Massenberg (703) 431-4247

Inspection Date: Dec. 4, 2019 and Dec. 10, 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

Technical Assistance:
Documentation was discussed with the provider.

Comments:
An announced initial inspection was conducted on 12/4/19 (3:00 PM - 5:45 PM). LI walked the physical plant and completed room measurements. Staff records, facility policies, and facility procedures were reviewed. The call bell system was tested. Criminal Background Checks were reviewed for all staff currently hired. Additional measurements were completed on 12/10/19. Violations were discussed and an exit meeting was held. 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 standards, 2) Measures to prevent the non-compliance from occurring again, and 3) Person responsible for implementing each step and/or monitoring any preventative measures. Thank you for your cooperation and if you have any questions, please contact me via e-mail at m.massenberg@dss.virginia.gov.

Violations:
Standard #: 22VAC40-73-250-D
Description: Based on record review, the facility failed to ensure that each staff member annually submits the results of a risk assessment, documenting that the individual is free 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 of Staff #3 was reviewed during the inspection. The most recent tuberculosis risk assessment, included in the record for Staff #3, was dated 9/17/18. The risk assessment was more than a year old at the time of the inspection.

Plan of Correction: Staff # 3 has not started working for Vienna Manor of Fairfax as of 12/23/2019. Staff number #3 tuberculosis risk assessment was updated right away. The administrator reviewed all staff tb risk assessment to make sure its all updated before the 1st day of their work at Vienna manor of Fairfax.

Standard #: 22VAC40-73-550-G
Description: Based on record review, the facility failed to review the rights and responsibilities of residents in assisted living facilities annually with each staff person.
Evidence: The records of Staff #?s 1-3 were reviewed during the inspection. The most recent review of resident rights, included in the record for Staff #1, was dated 6/23/18. The most recent review of resident rights, included in the record for Staff #2, was dated 1/10/18. The most recent review of resident rights, included in the record for Staff #3, was dated 9/17/18.

Plan of Correction: The most recent review of resident's rights for staff #1-3 dated March 7,2019 was file on their HR record in Oakton location. The administrator obtained a copy of their most recent review of resident's rights and re-file it on their HR file for Vienna manor of Fairfax. The administrator will ensure all their HR file are transferred to the new location.

Disclaimer:
This information is provided by the Virginia Department of Social Services, which neither endorses any facility nor guarantees that the information is complete. It should not be used as the sole source in evaluating and/or selecting a facility.

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