VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Avalon House on Woodland Drive
6809 Woodland Drive
Falls church, VA 22046
(301) 656-8823

Current Inspector: Amanda Velasco (703) 397-4587

Inspection Date: Jan. 31, 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 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.

Comments:

An unannounced monitoring study was conducted from 8:30 a.m. - 3:00 p.m. on 01/31/2020. At the time of entrance 6 residents were in care. The sample size consisted of four resident records and three staff records. Three residents and staff were interviewed. Resident and staff records and other documentation reviewed including Criminal Background Checks of all staff hired since previous inspection conducted on 09/20/2018 were reviewed. Residents were observed eating breakfast and lunch and engaging in activities including exercise. Medication administration was observed with one staff and medication bins observed for PRN medications. Building and Grounds observed. Violations and risk ratings reviewed and exit interview held with Adminsitrator. 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 #:	22VAC40-73-250-E
Description:	Based on record review and interview, facility failed to ensure that staff records shall include record of any vaccinations and immunizations received including documentation of screening and immunizations offered to, received by, or declined by employees. Evidence: 2/3 staff records did not include documentation of vaccinations received. Staff #1 consented to hepatitis vaccination on 8/2/2018 and documentation of vaccinations was not in record; and Staff #2 consented to hepatitis vaccination on 6/16/2019 and documentation of the first vaccination on 6/16/2019 was in record and documentation of the second and third vaccinations was not in record.
Plan of Correction:	RN will ensure they document each round of the hepatitis vaccination in the staff chart if the staff did not decline the hepatitis vaccinations. Administrator will work with the RN to remind them of this documentation & ensure this is charted.
Standard #:	22VAC40-73-650-B
Description:	Based on record review and interview, facility failed to ensure that physician or other prescriber orders for administration of all prescription medications shall identify the diagnosis, condition, or specific indications for administering each drug. Evidence: Orders for Resident #1's Trulance ordered on 10/3/2019 and Lidoc/Mylan ordered on 12/12/2019 did not identify the diagnosis, condition or specific indications for administering each drug.
Plan of Correction:	Medication Technician will receive a training which entails the importance of the diagnosis being included on all medication orders as well as how to obtain that information from a physician if it is not included on the orders. RN will check the orders monthly to ensure they are included.