VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Goodwin House Alexandria
4800 Fillmore Ave
Alexandria, VA 22311
(703) 824-1000

Current Inspector: Nina Wilson (703) 635-6074

Inspection Date: June 24, 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 6/24/2020 and concluded on 6/25/2020. The administrator was contacted by telephone to initiate the inspection. The administrator reported that the current census was 54. 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 #:	22VAC40-73-1090-A
Description:	Based in record review, facility failed to ensure that prior to his admission to a safe, secure environment, the resident shall have been assessed by an independent clinical psychologist or by an independent physician as having a serious cognitive impairment and the assessment shall include the following areas: Thought and perception (e.g., process and content). Evidence: Resident #4 was admitted into a safe, secure area on 4/8/2020 with an Assessment of Serious Cognitive Impairment signed and dated on 4/7/2020 and the Thought and Perception area was not completed.
Plan of Correction:	The Assessment of Serious Cognitive Impairment forms for all residents living in the safe and secured environment will be audited by the Administrator. If the document is incomplete, the resident?s physician will complete a new assessment. The Administrator and Charge Nurse will review all new Assessments of Serious Cognitive Impairment for completion prior to a resident admission to the safe and secured environment. Responsible Person: Assisted Living Administrator