VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Sunrise at Hunter Mill
2863 Hunter Mill Road
Oakton, VA 22124
(703) 255-1006

Current Inspector: Alexandra Roberts

Inspection Date: June 12, 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.

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 monitoring inspection was initiated on 6/12/2020 and concluded on 6/24/2020. The administrator was contacted by telephone to initiate the inspection. The administrator reported that the current census was 69. The inspector emailed the administrator a list of items required to complete the inspection. The inspector reviewed 4 resident records and 4 staff records. Criminal record checks and sworn statements of all staff hired since last inspection and other documentation submitted by the facility was reviewed to ensure documentation was complete. Information gathered during the inspection determined non-compliance(s) with applicable standards or law, and violations were documented on the violation notice issued to the facility.

Violations:

Standard #:	22VAC40-73-1100-A
Description:	Based on record review, facility failed to ensure that prior to placing a resident with a serious cognitive impairment due to a primary psychiatric diagnosis of dementia in a safe, secure environment, the facility shall obtain the written approval of one of the following persons, in the following order of priority: the resident, a guardian or other legal representative for the resident if one has been appointed, a relative, or an independent physician. Evidence: Resident #2 was admitted to the safe, secure unit on 1/29/2020 and the Approval for Placement in Special Care Unit form was signed and dated by the Attorney in Face on 2/13/2020, after the admission date.
Plan of Correction:	A.) With respect to the specific residence/situation cited: Resident #2 received signed approval for admission of safe and secure unit on 2/13/2020 when Responsible Party signed Approval for Placement form. B.) With respect to how the facility will identify resident/situations with the potential for the identified concerns: The Reminiscence Coordinator (RC) or designee will conduct an initial audit of the safe and secure form for cognitively impaired current residents to confirm the forms are in the resident files. Issues that may be identified will be addressed and resolved. C.) With respect to what systemic measures have been put into place to address the state stated concern: The RC or designee will implement a process to monitor and audit receipt of the written approval for safe and secure environment prior to move in for each resident with cognitive impairment, monthly for 3 months. ED or designee will review resident files prior to move in for new move in`s to confirm safe and secure approvals at the RC weekly 1 to 1 meetings starting on 7/2/2020. During and after the 3 months, the QAPI committee will evaluate the results of the safe and secure environment approval forms audit and determine if continued audits are needed and/or if additional actions are necessary. D.) With respect to how the plan of correction will be monitored: The Executive Director or designee is responsible for the implementation and continued adherence to the various steps outlined in this Plan of Correction. Additionally, the ED is responsible for addressing and resolving concerns that may arise related to the implementation of adherence.
Standard #:	22VAC40-90-30-B
Description:	Based on record review, facility failed to ensure that the sworn statement or affirmation shall be completed for all applicants for employment. Evidence: Staff #22 was hired on 1/4/2019 with a Sworn Statement dated 4/4/2019 after hired, not an applicant.
Plan of Correction:	A.) With respect to the specific residence/situation cited: Staff #22 continues to be employed at the community and the ED reviewed the VA requirements for sworn statements on 4/4/2019 with staff #22. B.) With respect to how the facility will identify residents/situations with the potential for identified concerns: BOC or designee will conduct an initial audit of the sworn statements for current team member to confirm there are sworn statements in the file. Issues that may be identified will be addressed and resolved. C.). With respect to what systemic measures have been put into place to address the stated concern: BOC or designee will implement a process to monitor an audit receipt of the sworn statements prior to the first day of employment for new team members, monthly for 3 months. ED or designee will review new team member checklists, which include a sworn statement component, for new team members with BOC during weekly 1 to 1 meeting, beginning on 7/2/2020. During and after the 3 months, the QAPI committee will evaluate the results of the team member file audits of sworn statements to determine if continued audits are needed and or if additional actions are necessary. D.) With respect to how the plan of corrections will be monitored: The Executive Director or designee is responsible for the implementation and continued adherence to the various steps outlined in this Plan of Correction. Additionally, the ED is responsible for addressing and resolving concerns that may arise to the implementation and adherence.