VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Brightview Fair Oaks, LLC
12725 Lee Highway
Fairfax, VA 22030
(571) 495-5907

Current Inspector: Sarah Pearson (540) 680-9469

Inspection Date: Dec. 14, 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 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS Article 1 Subjectivity 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:

Discussed the following: 1. Standard 450 regarding ISP training and filing 2. Filing placement of Resident TB screening 3. Fall Risk Rating completion after fall and filing of form

Comments:

An unannounced monitoring inspection was conducted on 12/15/2021. At the time of entrance 29 residents were in care. The sample size consisted of six resident records, three staff records and two individual interviews. Resident and staff records and other documentation were reviewed. Criminal Background Checks of all staff hired after previous inspection on 8/5/2021 were reviewed. Residents were observed eating breakfast. Medication administration was reviewed. COVID-19 protocols are in place. Exit interview held. 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 #:	22VAC40-73-320-A
Description:	Facility failed to ensure that within the 30 days preceding admission, a person shall have a physical examination by an independent physician. The report of such examination shall be on file at the assisted living facility and shall contain the following: General physical condition, including a systems review as is medically indicated and any recommendations for care including medication, diet, and therapy Evidence: Resident #5's admission physical dated 9/1/2021 did not include documentation of the resident's general physical condition, including a systems review. Resident #5's admission physical dated 9/1/2021 and Resident #6's admission physical dated 9/25/2021 indicated that the medication list was attached however the documentation was not attached to the physical.
Plan of Correction:	Health Services Director will ensure that all admission documents are completed and will avoid attaching information to forms and require providers to document directly on the form.