VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Heatherwood Independent and Assisted Living
9642 Burke Lake Road
Burke, VA 22015
(703) 425-1698

Current Inspector: Jacquelyn Kabiri (703) 397-3017

Inspection Date: May 6, 2021

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 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. 22VAC40-80 THE LICENSING PROCESS.

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 renewal inspection was initiated on 5/6/21 and concluded on 5/10/21. The administrator was contacted by telephone to initiate the inspection. The administrator reported that the current census was 92. The inspector emailed the administrator a list of items required to complete the inspection. The inspector reviewed five resident records, five staff records, local fire and health inspections, and other documentation submitted by the facility to ensure documentation was complete. 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. 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 standards, 2) Measures to prevent the non-compliance from occurring again, and 3) Person responsible for implementing each step and/or monitoring any preventative measures. Thank you for your cooperation and if you have any questions, please contact me via e-mail at m.massenberg@dss.virginia.gov.

Violations:

Standard #:	22VAC40-73-260-A
Description:	Based on record review, the facility failed to ensure that each direct care staff member maintains certification in first aid. Each direct care staff member who does not have current certification in first aid shall receive certification in first aid within 60 days of employment. Evidence: The record for Staff #1, hired 11/16/20 as a caregiver, was reviewed during the inspection. The facility provided CPR/AED certification for Staff #1 that was issued on 8/27/19. Staff #1's record did not contain documentation of first aid certification that was completed within 60 days of her employment. No additional documentation was provided by the facility.
Plan of Correction:	Complete an in-house audit of all direct care staff to ensure a current certificate of first aid is on file. Any staff noted without a current first aid certificate will complete and provide proof of certification. To be completed on or before 6/15/2021
Standard #:	22VAC40-73-680-D
Description:	Based on record review, the facility failed to ensure that medications are administered in accordance with the physician's instructions and consistent with the standards of practice outlined in the current registered medication aide curriculum approved by the Virginia Board of Nursing. Evidence: Resident #2's April MAR (medication administration record) was reviewed during the inspection. Resident #2's record contained an order for Amiodarone, dated 4/1/21, that called for the resident to receive one 200mg tablet daily. The MAR documented that Resident #2's Amiodarone was not administered on 4/5/21, as the facility was waiting for the medication to be delivered. Resident #4's April MAR was reviewed during the inspection. Resident #4's record contained an order for Vitamin B-12, dated 6/22/19, that called for the resident to receive one 1500 mcg tablet daily. The MAR documented that Resident #4's Vitamin B-12 was not administered on 4/4/21, as it was pending delivery from the resident's family.
Plan of Correction:	Complete an in-house audit of 100% residents on medication management to ensure all medications on Physician Order Summary are in stock. All LPNs and Medication Techs to be in-service on the following: Timely reordering/notifications to pharmacy and families when less than 5-day supply of medications remain. To be completed on or before 6/1/2021