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Ashby Ponds, Inc.
21160 Maple Branch Terrace
Ashburn, VA 20147
(571) 291-6210

Current Inspector: Sarah Pearson (540) 680-9469

Inspection Date: July 14, 2021 and July 16, 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
22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS

Article 1
Subjectivity
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.
22VAC40-80 THE LICENSING PROCESS.

Technical Assistance:
A completed Renewal Application must be submitted prior to the expiration of the current license. The facility should receive an application in the mail, however if an application has not been received one can be obtained from the DSS web site.

Comments:
A renewal inspection was initiated on 7/14/2021 and concluded on 7/16/2021. The administrator was contacted by telephone to initiate the inspection. The administrator reported that the current census was 89. The inspector emailed the administrator a list of items required to complete the remote documentation review portion of the inspection. The inspector reviewed five resident records, five staff records, healthcare and dietary oversight reports, annual fire and health inspection reports, staff work schedule, and fire drill reports submitted by the facility to ensure documentation was complete. Criminal Background Checks of all staff hired since the previous inspection conducted on 4/12/2020 were reviewed. The inspector completed the on-site portion of the inspection on 7/16/2021. An exit interview was conducted with the administrator, director of nursing, and resident care coordinators on 7/16/2021, where findings were reviewed and an opportunity was given for questions, as well as for providing any information or documentation which was not available during the inspection.

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 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 #: 22VAC40-73-320-A
Description: Based upon a review of records, the facility failed to ensure that within the 30 days preceding admission, a person shall have a physical examination by an independent physician. The report of such examination shall be on file at the assisted living facility and shall contain the following: height, weight, and blood pressure.

Evidence: For Residents #3, #4, and #5, neither height nor weight were included on the report of physical examination form submitted to the facility.

Plan of Correction: 1. The history and physical of Resident's #3, #4, and #5 cannot be updated with current information. Weight and blood pressure of these residents have been updated monthly and are up-to-date in resident's records.
2. Practice Administrator or designee will ensure that 100% of medical providers who complete assisted living/memory care resident admission paperwork receive education specifying that the history and physical must be completed in full and shall contain height, weight, and blood pressure. Education completed by 8/30/2021.
3. Memory Care Manager or designee will ensure that 100% of the healthcare sales team receives education regarding required components on the history and physical. Education completed by 8/30/2021.
4. Healthcare counselor or designee will audit 100% of new resident admission paperwork to ensure that the history and physical is completed in full, including height, weight, and blood pressure; ongoing for 3 months. Completion by 10/30/2021.
5. Date to be corrected 10/30/2021.

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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