VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Beverly Assisted Living
3408 Beverly Drive
Annandale, VA 22003
(571) 308-3793

Current Inspector: Jacquelyn Kabiri (703) 397-3017

Inspection Date: Oct. 20, 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. 22VAC40-80 THE LICENSING PROCESS. 22VAC40-80 COMPLAINT INVESTIGATION. 22VAC40-80 SANCTIONS.

Technical Assistance:

Please forward the updated Health Inspection, Job Description and Dietary Oversight to the Licensing Office when you receive it.

Comments:

A renewal inspection was initiated on 10/20/2021 and concluded on 10/21/2021. The Owner/Administrator was contacted by telephone to initiate the inspection. The Owner/Administrator reported that the current census was eight. The inspector emailed the Owner/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, Health Care Oversight, staff schedule, menu and emergency drills submitted by the facility to ensure documentation was complete. The inspector conducted the on-site portion of the inspection on 10/21/2021. An exit interview was conducted with Owner/Administrator on the date of inspection, 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. The information gathered during the inspection determined no violations with applicable standards or law. No violations were issued.