VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Harmony at Chantilly
2980 Centreville Road
Herndon, VA 20171
(703) 994-4561

Current Inspector: Amanda Velasco (703) 397-4587

Inspection Date: Aug. 18, 2021

Complaint Related: No

Areas Reviewed:

22VAC40-73 RESIDENT CARE AND RELATED SERVICES

Comments:

A non-mandated self-report inspection was initiated on 8/18/21 and concluded on 9/30/21. A self-reported incident was received by the department regarding an allegation in the area of: Resident Care and Related Services. The licensing inspector emailed the administrator a list of documentation required to complete the investigation. The licensing inspector conducted on-site observations at the facility on 8/18/21 and 9/21/21. The evidence gathered during the investigation supported the allegation of non-compliance with standards or law, and a violation was issued. Any violations not related to the self-report but identified during the course of the investigation can be found on the violation notice.

Violations:

Standard #:	22VAC40-73-460-D
Description:	Based on documentation, the facility failed to provide supervision of resident schedules, care, and activities, including attention to specialized needs, such as prevention of falls and wandering from the premises. Evidence: Facility documentation states that Resident #1 was observed near the Dulles Health and Rehab Center on 7/28/21. Resident #1 was reported to have eloped from the facility's safe, secure environment, through an unlocked door. Resident #1 uses a wheelchair and her UAI (Uniform Assessment Instrument), dated 9/10/20, states that she needs assistance for wheeling and mobility. Resident #1's record contains an Assessment of Serious Cognitive Impairment, dated 8/26/20, that states that the resident has a serious cognitive impairment and that she is unable to recognize danger or protect her own safety and welfare.
Plan of Correction:	1. All exits have been checked and door lock systems are functional. 2. At shift change caregivers will count residents. 3. After each meal, residents will be counted. 4. HCD will monitor compliance.