VIRGINIA DEPARTMENT OF SOCIAL SERVICES

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

Current Inspector: Amanda Velasco (703) 397-4587

Inspection Date: March 6, 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 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 monitoring inspection was conducted on 3/6/20. At the time of entrance, eight residents were in care. A meal, medication administration, and an activity were observed. Building and grounds were inspected and records were reviewed. The sample size consisted of four resident records and three 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 #:	22VAC40-73-260-A
Description:	Based on record review, the facility failed to ensure that each direct care staff member maintains current certification in first aid. Each direct care staff member who does not have current certification in first aid shall receive certification in first aid within 60 days of employment. Evidence: The file for Staff #2, hired 12/11/19, was reviewed during the inspection. Staff #2, a certified nurse aide, had current certification in CPR, but no documentation of First Aid certification was provided during the inspection.
Plan of Correction:	The administrator contacted employee #1 to bring her first aid certification, and copy of her first aid certification will be filed in her HR record. The administrator will add another layer of audit to ensure required documentation is filed in their record.
Standard #:	22VAC40-73-680-C
Description:	Based on observation and documentation, the facility failed to ensure that medications are administered not earlier than one hour before and not later than one hour after the facility's standard dosing schedule. Evidence: The morning medication administration, for Resident #2, was observed during the inspection. Resident #2's Preservision capsule, ordered 1/9/20, was not given during the scheduled 8:00 AM medication administration. The medication was not given until after 11:00 AM.
Plan of Correction:	The Administrator immediately educated the MT that preservision capsule can be given right away (extra dose is available for replacement) to the resident until 9am. The administrator will provide an additional in service to review our medication management program.