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Vienna Manor IV, LLC
3903 Estel Road
Fairfax, VA 22031
(703) 218-1891

Current Inspector: Marshall G Massenberg (703) 431-4247

Inspection Date: March 8, 2022

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
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.

Comments:
An unannounced monitoring inspection was conducted on 3/8/22. At the time of entrance, eight residents were in care. A meal, medication administration, and an activity were observed. Building and grounds were inspected and records were reviewed. The sample size consisted of four resident records and three staff records. Violations were discussed and an exit meeting was held. 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 standards, 2) Measures to prevent the non-compliance from occurring again, and 3) Person responsible for implementing each step and/or monitoring any preventative measures. Thank you for your cooperation and if you have any questions, please contact me via e-mail at m.massenberg@dss.virginia.gov.

Violations:
Standard #: 22VAC40-73-250-D
Description: Based on record review, the facility failed to ensure that each staff member submits, on or within seven days prior to the first day of work at the facility, the results of a tuberculosis risk assessment documenting the absence of tuberculosis in a communicable form. The risk assessment shall be no older than 30 days.
Evidence: The record for Staff #1, hired 8/9/21, was reviewed during the inspection. Staff #1's orientation form and the facility's work schedule listed 8/9/21 as Staff #1's first day of work. Staff #1's tuberculosis risk assessment was dated 8/11/21. Staff #1's risk assessment was not submitted on or within seven days, prior to her first day of work at the facility.

Plan of Correction: Staff #1 had TB screen completed on 8/11/2021, it was delayed due to staff unable to make a doctor appointment before 8/9/2022 due to covid restriction and staffing shortage. Administrator contacted another medical provider that can provide TB screen for staff on as needed basis. Managers and Staff reeducated that TB screen needs to be done prior or on the first day of work.

Standard #: 22VAC40-73-260-A
Description: Based on record review and interview, the facility failed to ensure that each direct care staff member maintains current certification in first aid from the American Red Cross, American Heart Association, National Safety Council, American Safety and Health Institute, community college, hospital, volunteer rescue squad, or fire department. Each direct care staff member who does not have current certification in first aid, shall receive certification in first aid within 60 days of employment.
Evidence: The record for Staff #2, hired 12/24/19, was reviewed during the inspection. Staff #2's first aid certification expired on 1/24/22. No additional documentation was provided during the inspection. Facility staff confirmed that Staff #2 did not have current first aid certification from an approved provider.

The record for Staff #3, hired 6/1/21, was reviewed during the inspection. Staff #3's record contained first aid certification that was completed on 9/7/21. Staff #3's first aid certification was not received within 60 days of her employment.

Plan of Correction: Staff #2's first aid was not renewed on January due to the class being cancelled by the administrator due to high number of covid in Fairfax county area. Staff #2's First aid is immediately renewed by an approved provider.

Staff #3 first aid was completed after 60 days of employment due to limited number of first aid class. The administrator reeducated staff that first aid class needs to be completed within 60 days of employment.

Disclaimer:
This information is provided by the Virginia Department of Social Services, which neither endorses any facility nor guarantees that the information is complete. It should not be used as the sole source in evaluating and/or selecting a facility.

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