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

Current Inspector: Laura Lunceford (540) 219-9264

Inspection Date: June 5, 2020

Complaint Related: Yes

Areas Reviewed:
22VAC40-73 RESIDENT CARE AND RELATED SERVICES
22VAC40-73 BUILDING AND GROUNDS

Comments:
This inspection was conducted by licensing staff using an alternate remote protocol, necessary due to a state of emergency health pandemic declared by the Governor of Virginia.

A complaint inspection was initiated on 6/5/2020 and concluded on 6/9/2020. A complaint was received by the department regarding allegations in the areas of supervision and neglect. The administrator was contacted by email to conduct the investigation. The licensing inspector emailed the administrator and memory care coordinator a list of documents required to complete the investigation.

The evidence gathered during the investigation did not support the allegations of non-compliance with standards. Any violations not related to the complaint but identified during the course of the investigation can be found on the violation notice.

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 e-mail at jamie.eddy@dss.virginia.gov.

Violations:
Standard #: 22VAC40-73-440-A
Complaint related: No
Description: Based upon a review of residents' records, the facility failed to ensure that all residents of and applicants to assisted living facilities shall be assessed face to face using the uniform assessment instrument in accordance with Assessment in Assisted Living Facilities (22VAC30-110). The UAI shall be completed at least annually.

Evidence: For Resident #2, a UAI (Uniform Assessment Instrument) was completed on 3/5/2019, the next UAI was not completed until 5/27/2020.

Plan of Correction: The Uniform Assessment Instrument (UAI) for Resident #2 was completed on 5/27/2020; it is duly noted that it was not completed within one year as the regulations states. The Vice President of Resident Experience, or designee, will conduct an audit of UAIs to ensure they are completed at least annually for all residents.

Standard #: 22VAC40-73-930-D
Complaint related: No
Description: Based upon a review of resident's records and statements from staff, the facility failed to ensure for each resident with an inability to use the signaling device, in addition to any other services, the following shall be met: this inability shall be included in the resident's individualized service plan. The plan shall specify a minimal frequency of daily rounds to be made by direct care staff to monitor for emergencies or other unanticipated resident needs.

Evidence: The Individualized Service Plan (ISP) for Resident #2 states that the resident has access to a pendant and pull cords and that "care team will do rounds" to make sure the resident's needs are being met. The ISP fails to include that the resident has an inability to use the call bell system due to her impaired cognitive status and does not specify a minimal frequency of rounds to be made by direct care staff.

Plan of Correction: The Individualized Service Plan (ISP) for Resident #2 was updated on 6/19/2020 to include the resident has inability to use the call bell system due to impaired cognition and rounding will occur at least twice on each shift by direct care staff. The Vice President of Resident Experience, or designee, will conduct an audit of ISPs to ensure they are updated to include ability to use the call bell system and the minimal frequency of daily rounds by direct care staff to monitor for emergencies or other anticipated resident needs.

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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