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Culpepper Garden III INC
4439 N. Pershing Drive
Arlington, VA 22203
(703) 528-0162

Current Inspector: Alexandra Roberts

Inspection Date: Jan. 19, 2021 and Jan. 23, 2021

Complaint Related: Yes

Areas Reviewed:
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

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 complaint inspection was initiated on 1/19/2021 and concluded on 1/23/2021. A complaint was received by the department regarding allegations in the areas of Buildings and Grounds. The Administrator was contacted by telephone 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 supported the allegation of non-compliance with standards or law, and violations were issued. Any violations not related to the complaint but identified during the course of the investigation can be found on the violation notice.

Violations:
Standard #: 22VAC40-73-870-D
Complaint related: No
Description: Based on documentation and interviews, facility failed to ensure that buildings shall be kept free of infestations of insects

Evidence: Interview with Resident #1's daughter on telephone on 1/11/2021 and email on 1/12/2021 stated pests were observed and photographed in Resident #1's apartment #240 on 1/2/2021 and on 1/3/2021 while removing Resident #1s personal items after Resident #1's discharge on 12/24/2020; resident's daughter stated Staff #1 was notified by email on 1/4/2021 regarding pests with photographs. Interview with Staff #1 on 1/19/2021 stated that she was notified on 1/4/2021 by Resident #1's daughter of the pests by email; facility staff and pest control management on-site observed pests in room #240 on 1/4/2021 and treatment was started. Staff #1 stated a call was made to the daughter on 1/4/2021 to discuss observation and plan of action. Pest management company documented pest treatment in Resident #1's apartment #240 and noted on 7/28/2020 "Heavy activity found" and on 12/3/2020 "Some activity in kitchen" and on 1/4/2021 "Treated the unit thoroughly for cockroaches. Treated all the furniture, kitchen, bathroom and bedroom with closets and baseboards".

Plan of Correction: An inspection of room 240 was immediately conducted by the Assisted Living Administrator, Director of Plant Operations, and the Pest Control Vendor on 1/4/2021, the day that the problem was reported. The Pest Control Vendor was immediately notified to provide additional treatment for pests to apartment 240 that same day and additional treatments to room thereafter. A room-by-room inspection was completed by the Assisted Living Administrator and the Director of Plant Operations on 1/6/2021. An intensive treatment of each room was completed by the Pest Control Vendor. The Assisted Living Administrator and Director of Plant Operations along with the Pest Control Vendor completed training for the nursing staff, the housekeeping, and other support services on 1/7/21 and 1/11/21. The training included how to properly identify pest control opportunities and proper reporting of those opportunities. Weekly inspections will be completed by a designated maintenance team member with a Bi-Weekly follow up by the Director of Plant Operations. The Assisted Living Administrator will complete a subsequent review monthly for 3 months.

Disclaimer:
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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