VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Greenspring Village
7470 Spring Village Dr
Springfield, VA 22150
(703) 923-4663

Current Inspector: Alexandra Roberts

Inspection Date: Nov. 19, 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 inspection was initiated on 11/19/2020 and concluded on 11/23/2020. The administrator was contacted by telephone to initiate the inspection. The administrator reported that the current census was138 . The inspector emailed the administrator a list of items required 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. Documentation of incident reports since last inspection reviewed. 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.to complete the inspection. The inspector reviewed 5 resident records and 5 staff records.

Violations:

Standard #:	22VAC40-73-1090-A
Description:	Based on 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 licensed to practice in the Commonwealth or by an independent physician as having a serious cognitive impairment due to a primary psychiatric diagnosis of dementia with an inability to recognize danger or protect his own safety and welfare. Evidence: Resident #5 was admitted to a Safe, Secure Unit (SSU) on 1/31/2019 with a assessment dated 1/29/2019 and the provider answered "No" to the question "is the individual named above unable to recognize danger or protect his/her own safety and welfare?".
Plan of Correction:	1.) The originally completed form was checked ?No? by the provider in error. A new form is to be completed by a provider and attached to the initial document. 2.) A 100% audit of the Memory Care (SSU) neighborhood will be completed by the Memory Care Manager or designee to ensure that both boxes have been checked ?Yes? by the physician for all current Memory Care residents. Any resident?s identified with boxes checked ?No? will have a new form completed by the physician and attached to the original. 3.) Greenspring Village physicians will be reeducated by the Practice Administrator on proper completion of the physician?s assessment form.
Standard #:	22VAC40-73-1110-A
Description:	Based on record review facility failed to ensure that prior to admitting a resident with a serious cognitive impairment to a safe, secure unit, the licensee, administrator, or designee shall determine whether placement in the special care unit is appropriate. Evidence: Resident #2 was admitted to an SSU on 7/14/2019 and an appropriateness assessment was not completed by the licensee, administrator, or designee.
Plan of Correction:	1.) Resident #2 expired on 01/13/2021. 2.) A 100% audit of the Memory Care (SSU) neighborhood will be completed by the Memory Care Manager or designee to ensure that appropriateness assessments have been signed by the licensee, administrator, or designee. 3.) Admissions team and Assisted Living Managers will be reeducated on proper completion of the appropriateness for by the licensee, administrator, or designee.