VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Harmony at Chantilly
2980 Centreville Road
Herndon, VA 20171
(703) 994-4561

Current Inspector: Amanda Velasco (703) 397-4587

Inspection Date: May 24, 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 ACCOMMODATIONS AND RELATED PROVISIONS 22VAC40-73 BUILDINGS AND GROUND 22VAC40-73 EMERGENCY PREPAREDNESS 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS 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

Comments:

An unannounced renewal inspection was conducted on 5/24/22. At the time of entrance, 54 residents were in care. Meals, medication administration, and activities were observed. Building and grounds were inspected. Records were reviewed. The sample size consisted of four staff records and eight resident 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 annually submits the results of a tuberculosis 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: The record for Staff #2 was reviewed during the inspection. The most recent TB risk assessment, included in Staff #2?s record, was completed in 2018. The record for Staff #3 was reviewed during the inspection. The most recent TB risk assessment, included in Staff #3?s record, was dated 1/22/21. The record for Staff #4 was reviewed during the inspection. The most recent TB risk assessment, included in Staff #4?s record, did not include the findings of the risk assessment.
Plan of Correction:	The business office manager will have a binder and maintain these records, to ensure all are in compliance.
Standard #:	22VAC40-73-260-A
Description:	Based on record review, the facility failed to ensure that each direct care staff member maintains certification in first aid. 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: First aid certifications were not found in the records of Staff #2 (hired 1/9/17) or Staff #4 (hired 9/28/17).
Plan of Correction:	The business office manager will keep a binder and ensure to advise staff of the need to renew said documentations per regulations. As well as ensure new staff have or get certified within 60 days. The business office manager and Interim Executive Director consequently found something and up to date documentation for said staff.
Standard #:	22VAC40-73-320-A
Description:	Based on record review, the facility failed to ensure that the physical examination form includes all of the required information. Evidence: Resident #4?s record was reviewed during the inspection. Resident #4?s physical examination form, dated 4/23/21, did not include the resident?s height, weight, blood pressure, or tuberculosis risk assessment.
Plan of Correction:	The director of sales and marketing will ensure the H&P is filled out according to regulations and ensure the Health care coordinator also reviews for accuracy prior to admission.
Standard #:	22VAC40-73-660-A
Description:	Based on observation, the facility failed to ensure that the medication storage area remains locked. Evidence: At 9:33 AM, the second floor medication cart was observed to be unlocked and unattended by medication administration staff. At 9:45 AM, the memory care medication cart was observed to be unlocked and unattended by medication administration staff.
Plan of Correction:	The staff member was educated on the importance and safety of securing the medication carts.