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: Sept. 14, 2021 and Sept. 22, 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 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:

A renewal inspection was initiated on 9/14/2021 and concluded on 9/22/2021. The administrator was contacted by telephone to initiate the inspection. The administrator reported that current census was five. The inspector emailed the administrator a list of items required to complete the remote documentation review portion of the inspection. The inspector reviewed two resident records, two staff records, staff work schedule, monthly menu, monthly activity schedule, fire drill reports, and annual fire and health inspection reports submitted by the facility to ensure documentation was complete. Criminal Background Checks of all staff hired since the previous inspection conducted on 12/14/2020 were reviewed. The inspector completed the on-site inspection on 9/16/2021. An exit interview was conducted with the administrator on 9/22/2021 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-compliances with applicable standards or law, and violations were documented on the violation notice issued to the facility. 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 #:	22VAC40-73-640-A
Description:	Based upon a review of records, the facility failed to implement a written plan for medication management to ensure that verification of medication orders have been accurately transcribed to medication administration records (MARs) within 24 hours of receipt of a new order or change in an order. Evidence: 1. The physician's order, dated 8/15/2021 for Resident #1 indicated that Levothyroxine is given for the diagnosis of hypothyroid. The September 2021 Medication Administration Record (MAR) for Resident #1 documents that the order for Levothyroxine is administered for bowl health. 2. Resident #2 has a physician's order dated 8/15/2021 indicating that Levothyroxine is to be administered for hypothyroid. The September 2021 MAR for Resident #2 reports that Levothyroxine is administered for anxiety.
Plan of Correction:	Will be careful to see why the medication is given and for what purpose. Will be careful to write the right diagnosis given by the Dr. and for what the medication is given.
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 include the name of the resident, the date of the order, the name of the drug, route, dosage, strength, how often medication is to be given, and identify the diagnosis, condition, or specific indications for administering each drug. Evidence: The physician's order for Melatonin 10mg dated 7/20/2021, did not include the diagnosis, condition, or specific indications for administering the drug.
Plan of Correction:	Will transcribe the physician's order correctly onto the MAR.
Standard #:	22VAC40-73-680-I
Description:	Based upon a review of records, the facility failed to ensure that the Medication Administration Record (MAR) included the following information: the date the medication was prescribed and the diagnosis. Evidence: The September 2021 MAR for Resident #1 includes an order for Melatonin but the diagnosis and the date the Melatonin was ordered is not documented on the MAR.
Plan of Correction:	Will transcribe all the information onto the MAR as written by the Dr.