VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Harmony at Chantilly
2980 Centreville Road
Herndon, VA 20171
(703) 994-4561

Current Inspector: Amanda Velasco (703) 397-4587

Inspection Date: Jan. 9, 2020

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 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS Article 1 Subjectivity 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:

Documentation was discussed with the provider

Comments:

An unannounced renewal inspection was conducted on 1/9/20 (7:30 AM - 6:00 PM). At the time of entrance, 54 residents were in care. Meals, medication administration, and activities were observed. Building and grounds were inspected and records were reviewed. The sample size consisted of eight resident records and four staff records. 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 #:	22VAC40-73-1140-B
Description:	Based on record review and interview, the facility failed to ensure that each direct care staff person attends at least 10 hours of training in cognitive impairment, within four months of the starting date of the staff member's starting date of employment in the safe, secure environment. Evidence: The record for Staff #4 was reviewed during the inspection. Facility staff reviewed the work schedules and reported that they believe that Staff #4 began working in the safe, secure environment on 8/25/19. The record for Staff #4 contained 7.5 hours of training in cognitive impairment, at the time of the inspection.
Plan of Correction:	Staff #4, hired 7/25/19, will receive three (3) additional hours of Cognitive Impairment training by 1/22/2020. The Executive Director and Business Office Manager will perform monthly audits of employee files, to verify that all staff members providing direct care in the Memory Care Neighborhood have the required ten (10) hours of Cognitive Impairment Training within four months of the date of hire. The Executive Director or designated Coordinator is responsible for confirming implementation and ongoing compliance with the components of this Plan of Correction and addressing and resolving variances that may occur.
Standard #:	22VAC40-73-250-D
Description:	Based on record review, the facility failed to ensure that each staff person submits the results of a risk assessment, within seven days prior to the first day of work at the facility, 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. The risk assessment shall be no older than 30 days. Evidence: The record for Staff #1, hired 10/23/19, was reviewed during the inspection. The record contained a chest x-ray from 2016. No tuberculosis risk assessment was observed, within 30 days prior to Staff #1's hire date. The record for Staff #4, hired 7/25/19, was reviewed during the inspection. The record contained a tuberculosis risk assessment, dated 5/18/19. The record also contained a risk assessment, dated 7/17/19, but the findings were not documented. No completed tuberculosis risk assessment was observed, within 30 days prior to Staff #4's hire date.
Plan of Correction:	On 1/09/2020, a tuberculosis risk assessment was completed by the Healthcare Director for Staff #1, hired on 10/23/2019. The assessment, documented on the approved Virginia Department of Health form, confirms the absence of tuberculosis in a communicable form. Within seven (7) days of employment, each team member shall submit the results of a risk assessment, documenting the absence of tuberculosis in a communicable form. The Healthcare Director, Executive Director, and Business Office Manager or designated Coordinator will perform monthly audits of employee files, to verify that tuberculosis risk assessments are no older than 30 days. The Executive Director or designated Coordinator is responsible for confirming implementation and ongoing compliance with the components of this Plan of Correction and addressing and resolving variances that may occur. On 1/09/2020, a tuberculosis risk assessment was completed by the Healthcare Director for Staff #4, hired 7/25/2019. The assessment, documented on the approved Virginia Department of Health form, confirms the absence of tuberculosis in a communicable form. Within seven (7) days of employment, each team member shall submit the results of a risk assessment, documenting the absence of tuberculosis in a communicable form. The Healthcare Director, Executive Director and Business Office Manager, or designated Coordinator will perform monthly audits of employee files, to verify that tuberculosis risk assessments are no older than 30 days. The Executive Director or designated Coordinator is responsible for confirming implementation and ongoing compliance with the components of this Plan of Correction and addressing and resolving variances that may occur.
Standard #:	22VAC40-73-320-A
Description:	Based on record review, the facility failed to ensure each resident has a physical examination within 30 days preceding admission. Evidence: The record for Resident #1, admitted 7/20/19, was reviewed during the inspection. Resident #1's physical examination was conducted on 6/5/19. The physical examination was more than 30 days old, at the time of the resident's admission.
Plan of Correction:	H&P reports will be verified prior to admission. The Healthcare Director and Executive Director will review each move in file and will perform monthly audits of resident files, to verify that all H&P documents are within acceptable timeframes, not to exceed 30 days prior to admission.