VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Vienna Manor IV, LLC
3903 Estel Road
Fairfax, VA 22031
(703) 218-1891

Current Inspector: Amanda Velasco (703) 397-4587

Inspection Date: Aug. 24, 2021

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 STAFFING AND SUPERVISION 22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-73 BUILDING AND GROUNDS

Comments:

A non-mandated inspection was initiated on 8/24/21 and concluded on 9/23/21. Complaints were received by the department regarding allegations in the areas of: Staffing and Supervision, Resident Care and Related Services, and Building and Grounds. The licensing inspector conducted on-site observations at the facility on 8/24/21, 9/17/21, and 9/23/21. The evidence gathered during the investigation supported the allegations of non-compliance with standards or law, and violations were issued. Any violations not related to the complaints but identified during the course of the investigation can be found on the violation notice.

Violations:

Standard #:	22VAC40-73-280-A
Complaint related:	Yes
Description:	Based on record review and documentation, the facility failed to have staff adequate in knowledge, skills, and abilities and sufficient in numbers to provide services to attain and maintain the physical, mental, and psychosocial well-being of each resident as determined by resident assessments and individualized service plans, and to ensure compliance with this chapter. Evidence: Resident #1's Uniform Assessment Instrument (UAI), dated 2/1/21, states that the resident needs two person assistance for bathing and transferring. Resident #1's Individualized Service Plan (ISP), dated 2/10/21, states that the resident needs two staff members for assistance with bathing and transferring. A therapy note, dated 2/10/21, states that Resident #1 is a fall risk "due to age/DX Parkinson's and office chair in his room." Resident notes, dated 4/27/21, state that Resident #1 was found sitting on the floor at 3:45 AM, next to his bed. The notes also state that a pharmacy delivery person assisted Staff #1 to get the resident up. Staff #1 reported that she was the only staff member on duty, at the time, and she was unable to lift Resident #1 by herself. The facility's staffing schedule, from 4/19/21 through 5/2/21, was reviewed during the inspection. On 13 occasions, only one staff person was on duty at night.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-680-D
Complaint related:	Yes
Description:	Based on record review and interview, 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 #1's May 2021 Medication Administration Record (MAR) was reviewed during the inspection. Resident #1's record contained an order, dated 3/27/21, that calls for the Resident to receive half of a 6.25mg Carvedilol tablet, twice per day. Additional information stated that the medication should only be given when Resident #1's Systolic Blood Pressure (SBP) is above 130. Resident #1's MAR indicated that the medication was held when the resident's SBP was above 130 on 5/13/21 (8 AM administration) and 5/14/21 (8 AM administration). Resident #1's SBP was documented as 149 on 5/13/21 (8 AM administration) and as 136 on 5/14/21 (8 AM administration).
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-680-E
Complaint related:	Yes
Description:	Based on record review and interview, the facility failed to ensure that medical treatments ordered by a physician or other prescriber are provided according to their instructions and documented in the resident record. Evidence: The August MAR for Resident #2 was observed during the inspection. The record for Resident #2 included an order, dated 4/20/21, that calls for the resident to use a CPAP machine one time per day at bedtime for Sleep Apnea. Resident #2's August MAR included the resident's daily need to use the CPAP machine, but no administration information was present for the month of August (at the time of the inspection). Facility staff reported that Resident #2 uses the CPAP machine at bedtime, but the administrations were not documented on the MAR. Resident #2's UAI, dated 4/19/21, states that the Resident needs medications to be administered/monitored by a lay person. Resident #2's ISP, dated 4/19/21, states that staff will administer all of her medications as ordered by her MD.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-680-I
Complaint related:	Yes
Description:	Based on record review, the facility failed to ensure that the MAR (Medication Administration Record) includes all of the required information. Evidence: Resident #1's May 2021 MAR was reviewed during the inspection. Resident #1's UAI, dated 2/1/21, states that the resident needs to have his medication administered/monitored by a lay person. Resident #1's ISP, dated 2/10/21, states that staff will administer meds as ordered by his physician. Resident #1 was prescribed Carvedilol (order date: 3/27/21), which was to be given when the resident's SBP was above 130. Resident #1's Carvedilol was held on 5/2/21 (8 AM and 8 PM administrations), 5/3/21 (8 AM and 8 PM administrations), and 5/14/21 (8 PM administration). The MAR did not document the reason that Resident #1's Carvedilol was held or the resident's SBP on 5/2/21 (8 AM and 8 PM administrations), 5/3/21 (8 AM and 8 PM administrations), or 5/14/21 (8 PM administration). Resident #1's MAR did not contain documentation about the administration of his Magnesium on 5/14/21 (8 PM administration).
Plan of Correction:	Not available online. Contact Inspector for more information.