VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Crystal Gardens Assisted Living, LLC
6712 Bostwick Drive
Springfield, VA 22151
(703) 642-5329

Current Inspector: Alexandra Roberts

Inspection Date: May 25, 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 5/25/21 and concluded on 5/26/21. The facility manager was contacted by telephone to initiate the inspection. The administrator reported that the census was four. The inspector emailed the administrator a list of items required to complete the inspection. The inspector reviewed two resident records, two staff records, medication administration 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 #:	22VAC40-73-680-I
Description:	Based on record review, the facility failed to ensure that the medication administration record (MAR) includes the diagnosis or condition for administering the drug or supplement. Evidence: Resident #1's April MAR was reviewed during the inspection. The MAR did not contain the diagnosis or condition for the administration of Resident #1's Mirtazapine. Resident #2's April MAR was reviewed during the inspection. The MAR did not contain the diagnosis or condition for the administration of Resident #2's Sertraline or Senna-S.
Plan of Correction:	MARs corrected right away after seeing the violation. Nurse, Medication Aides and MARs designee were instructed to ensure diagnosis or condition for administering the drug or supplement is always indicated.