VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Beverly Assisted Living on Trammell
7816 Trammell Road
Annandale, VA 22003
(571) 308-3793

Current Inspector: Laura Lunceford (540) 219-9264

Inspection Date: Dec. 8, 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:

A completed Renewal Application must be submitted prior to the expiration of the current license. An application can be obtained from the DSS website. Please mail the application and payment to VDSS ? Western Licensing Office, 190 Patton Street, Suite 100, Abingdon, VA 24210 ? ATTN: Application Processing

Comments:

An unannounced renewal inspection was conducted on 12/8/2021. At the time of entrance eight residents were in care with two staff providing care. The sample size consisted of three resident records, two staff records and one individual interview. Resident and staff records and other documentation were reviewed. No new staff have been hired since the previous inspection. Residents were observed eating breakfast and engaging in activities including current events, music appreciation and arts and crafts. Medication administration was observed. Violations reviewed with the Administrator during the exit interview. Thank you for your cooperation and if you have any questions please call 703-479-4708 or contact me via e-mail at lynette.storr@dss.virginia.gov.

Violations:

Standard #:	22VAC40-73-250-D
Description:	Facility failed to ensure that each staff person or household member required to be evaluated shall annually submit the results of a risk assessment, documenting that the individual is free of tuberculosis in a communicable form as evidenced by the completion of the current screening form published by the Virginia Department of Health or a form consistent with it. Evidence: Staff #1 & Staff #2 do not have documentation of a completed TB Risk Assessment.
Plan of Correction:	All staff records will be reviewed by the Administrator for documentation of current TB Risk Assessment.
Standard #:	22VAC40-73-250-E
Description:	Facility failed to ensure that documentation of screening and immunizations offered to, received by, or declined by employees in accordance with law, regulation, or recommendations of public health authorities is included in the staff record. Evidence: Staff #1 did not have documentation of current immunizations.
Plan of Correction:	Administrator will review each staff record to ensure immunizations are documented and retained.
Standard #:	22VAC40-73-260-A
Description:	Facility failed to ensure that each direct care staff member shall maintain current certification in first aid. Evidence: Staff #1 and Staff #2 do not have documentation of current First Aid Certification.
Plan of Correction:	Administrator will review all staff records to ensure documentation is in each staff record.
Standard #:	22VAC40-73-450-E
Description:	Facility failed to ensure that the Individualized Service Plan (ISP) shall be signed and dated by the licensee, administrator, or his designee, (i.e., the person who has developed the plan), and by the resident or his legal representative. The plan shall also indicate any other individuals who contributed to the development of the plan, with a notation of the date of contribution. The title or relationship to the resident of each person who was involved in the development of the plan shall be included. Evidence: Resident #1's ISP dated 10/20/2021 did not include signatures of the resident or her legal representative.
Plan of Correction:	Administrator will ensure that ISPs are signed by the resident or legal guardian.
Standard #:	22VAC40-73-560-E
Description:	Facility failed to ensure that all resident records shall be kept current, retained at the facility, and kept in a locked area. Evidence: Upon the Licensing Inspector's arrival the resident records were in an unlocked office in an open bookcase.
Plan of Correction:	The Administrator will ensure that the office door is closed and locked at all times.