VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Home Eldercare
10704 Orchard Street
Fairfax, VA 22030
(703) 273-3640

Current Inspector: Sarah Pearson (540) 680-9469

Inspection Date: Dec. 2, 2020 and Dec. 14, 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 32.1 Reported by persons other than physicians 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 12/02/2020 and concluded on 12/14/2020. The administrator was contacted by telephone to initiate the inspection. The administrator reported that the current census was five. The inspector emailed the administrator a list of required items required to complete the inspection. The inspector reviewed two resident records, two staff records, fire drill reports, annual fire inspection, and staff work schedule submitted by the facility to ensure documentation was complete. There have been no new hires since the last monitoring inspection that occurred on 9/18/2019. Information gathered during the inspection determined non-compliance with applicable standards or law, and violations were documented on the violation notice issued to the facility. The exit interview was held by telephone on 12/14/2020. 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 #:	22VAC40-73-650-B
Description:	Based upon a review of records, the facility failed to ensure that physician or other prescriber orders, both written and oral, for administration of all prescription and over-the-counter medications and dietary supplements shall identify the diagnosis, condition, or specific indications for administering each drug. Evidence: Resident #1's physician's orders dated 10/28/2020, did not include the diagnosis, condition, or specific indications for administering the following medications:: Zoloft, Simvastatine, Benazerpril, Levothyroxine, Aspririn, and Vitamin B-12.
Plan of Correction:	The facility will write the diagnosis for each medicine that the doctor has prescribed and for what it is given.
Standard #:	22VAC40-73-680-I
Description:	Based upon a review of records, the facility failed to ensure that the MAR (medication administration record) included the diagnosis, condition, or specific indications for administering the drug or supplement. Evidence: The December 2020 Medication Administration Record (MAR) for Resident #2 did not include the diagnosis, condition or specific indications for administering the following medications: Xarelto and Labetalol HCl.
Plan of Correction:	The facility will write the diagnosis on the MAR records of the residents.