VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Hunters Woods at Trails Edge
2222 Colts Neck Road
Reston, VA 20191
(703) 429-1130

Current Inspector: Jacquelyn Kabiri (703) 397-3017

Inspection Date: June 30, 2021

Complaint Related: No

Areas Reviewed:

22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES 22VAC40-73 RESIDENT CARE AND RELATED SERVICES

Comments:

On 06/30/2021 Licensing Inspector (LI) conducted unannounced inspection in response to self-reported incident. Reviewed resident records and other documentation. Conducted resident and staff interviews. Exit interview conducted with the Executive Director. Violation notice issued and assessed risk assigned to violations. 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, 3) person(s) responsible for implementing each step and/or monitoring any preventative measure(s), and 4) date that that plan of correction will be completed. Thank you for your cooperation and if you have any questions please call (703) 895-5627 or contact me via e-mail at jeannette.zaykowski@dss.virginia.gov.

Violations:

Standard #:	22VAC40-73-70-A
Description:	Based on record and documentation review and interviews, facility failed to ensure that each facility shall report to the regional licensing office within 24 hours any major incident that has negatively affected or that threatens the life, health, safety, or welfare of any resident. EVIDENCE: Resident 1 wandered from the facility on 05/28/2021 and the facility emailed an incident report to the Licensing Inspector on 05/30/2021 at 1:09 a.m.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-460-D
Description:	Based on record review, documentation and interview, facility failed to ensure that the facility shall provide supervision of resident schedules, care, and activities, including attention to specialized needs, such as the prevention of wandering from the premises. EVIDENCE: 1. Facility incident report dated 05/29/2021 and resident caregiver notes dated 05/29/2021 document that Resident 1 was returned to the facility by the daughter and the police on 05/28/2021 at about 9:40 p.m. after he had been observed wandering unaccompanied in the neighborhood and facility was not aware that the resident had left the facility. 2. Resident 1 interviewed on 06/30/2021 stated "I normally like to take a walk at night but I was on the trail and then came to a street corner and it was dusk and I didn't know where to go. I am new here." Resident signed the Resident Handbook on 05/24/2021 that includes the procedure to sign in and out of the building and when asked about the procedure stated "I don't recall that book but I am probably not able to do it because I sometimes forget things which is why I need to live here". 3. Resident 1's Uniform Assessment Instrument dated 05/1/2021 documents "appropriate" and Resident 1's Individual Service Plan onset date 05/24/2021 documents resident "enjoys going for walks/exercise" and "Direct Care Staff, Community Staff or private companion will accompany (resident) when he leaves the building." 4. Staff interviews on 06/30/2021 stated no knowledge of wandering behavior for Resident 1 prior to this incident.
Plan of Correction:	Not available online. Contact Inspector for more information.