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

Current Inspector: Amanda Velasco (703) 397-4587

Inspection Date: Sept. 11, 2020 and Sept. 30, 2020

Complaint Related: Yes

Areas Reviewed:

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 9/11/2020 and concluded on 9/30/2020. A complaint was received by the department regarding allegations in the areas of staffing quantity, staffing qualifications, and resident care. The administrator was contacted by email to conduct the investigation. The licensing inspector emailed the administrator a list of documentation required to complete the investigation.

The evidence gathered during the investigation supposed the allegations of non-compliance with standards or law, and violations were issued. 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

Standard #: 22VAC40-73-450-C
Complaint related: Yes
Description: Based upon a review of resident records, the facility failed to ensure that the comprehensive individualized service plan shall include the following: description of identified needs and date identified based upon the (i) UAI; a written description of what services will be provided to address identified needs, and if applicable, other services, and who will provide them; when and where the services will be provided; the expected outcome and time frame for expected outcome; and date outcome achieved.

Evidence: The UAI (Uniform Assessment Instrument), dated 6/5/2020, indicated Resident #2 needs no help with eating, but the ISP (Individualized Service Plan) dated 6/23/2020 dictates that the resident's food be cut up. On the ISP, dated 6/23/2020, for Resident #1, the date outcome achieved was missing for the following identified needs: dressing and orientation. Under the identified need of behavior the description of services to be provided only described the behavior of the resident on the ISP for Resident #1. The ISP, dated 6/23/2020, for Resident #2 failed to include the following information for some of the identified needs: persons who will provide services, when and where services will be provided, expected outcome and date of expected outcomes, and date goal achieved.

Plan of Correction: The Individualized Service Plan (ISP) for Residents #1 and #2 were updated to include all required components required by the regulations. The Vice President of Resident Experience, or designee, will conduct an audit of ISPs to ensure they are updated to include all required components.

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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(800) 828-1120, or 711