VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Harmony at Spring Hill
8350 Mountain Larkspur Drive
Fairfax, VA 22079
(571) 348-4970

Current Inspector: Amanda Velasco (703) 397-4587

Inspection Date: June 16, 2022 and June 17, 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 22VAC40-80 THE LICENSING PROCESS

Comments:

Type of inspection: Renewal The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. Number of residents present at the facility at the beginning of the inspection: 59 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: eight Number of interviews conducted with residents: four Additional Comments/Discussion: An unannounced renewal inspection was initiated on 6/16/22 (8:30 AM ? 6:43 PM) and continued on 6/17/22 (8:10 AM ? 4:40 PM). At the time of entrance, 59 residents were in care. Meals, medication administration, and an activities were observed. Building and grounds were inspected and records were reviewed. The sample size consisted of eight resident records and four staff records. The criminal background checks of new staff, hired since the last inspection, were observed for completion. Inspection findings were discussed and an exit meeting was held. The evidence gathered during the inspection determined non-compliance with applicable standard(s) or law, and violation(s) were documented on the violation notice issued to the facility. The licensee has the opportunity to submit a plan of correction to indicate how the cited violation(s) will be addressed in order to return the facility to compliance and maintain future compliance with applicable standard(s) or law. Please Note: A copy of the findings of the most recent inspection are required to be posted on the premises of the facility. For more information about the VDSS Licensing Programs, please visit: www.dss.virginia.gov Should you have any questions, please contact Marshall Massenberg, Licensing Inspector at (703) 431-4247 or by email at m.massenberg@dss.virginia.gov.

Violations:

Standard #:	22VAC40-73-1090-A
Description:	Based on record review, the facility failed to ensure that each resident is assessed by an independent clinical psychologist licensed to practice in the Commonwealth or by an independent physician as having a serious cognitive impairment due to a primary psychiatric diagnosis of dementia with an inability to recognize danger or protect his own safety and welfare, prior to his/her admission to the safe, secure environment. Evidence: The record for Resident #6 was reviewed during the inspection. Resident #6's Assessment of Serious Cognitive Impairment form, dated 3/23/22, states that the resident has the ability to recognize danger or protect her own safety and welfare. Resident #8?s Assessment of Serious Cognitive Impairment form, dated 2/9/22, states that the resident has the ability to recognize danger or protect her own safety and welfare.
Plan of Correction:	HCD or designee will ensure that each resident is assessed by an independent psychologist licensed to practice in the Commnonwealth or by an independent physician as having a serious cognitive imppairment due to primary psychiatric diagnosis of dementia with an inability to recognize danger or protect his own safety and welfare, prior to his/her admission to the safe, secure environment. Sales and Nursing were re-educated to ensure the compliance. The Executive Director or designee will ensure the implementation and on going compliance with the components of this plan of correction.
Standard #:	22VAC40-73-280-A
Description:	Based on observation and documentation, the facility failed to have staff adequate in knowledge, skills, and abilities and sufficient in numbers to provide services to attain and maintain the physical, mental, and psychosocial well-being of each resident as determined by resident assessments and individualized service plans, and to ensure compliance with this chapter. Evidence: On several occasions, memory care residents were observed to be gathered in the living room without a staff member present to provide supervision. Facility staff reported that they had been providing care to residents that required the assistance of two staff members. The June memory care staff schedules and resident records were reviewed during the inspection. Facility documentation indicated that there were four memory care residents that require the assistance of two people for transferring, toileting, or bathing. There were 16 residents on the memory care unit, during the inspection. Two staff members were consistently scheduled on the 1st and 3rd shifts, with the exception of 6/4/22 (one staff member on the 3rd shift) and 6/9/22 (three staff members on the 1st shift). There were seven days when there were three staff members on the 2nd shift and eight days when there were two staff members on the 2nd shift. There was also one day where four staff members were scheduled on the 2nd shift (6/9/22). During shifts with only two staff members; when care is provided to a resident that requires two-person assistance, there is no staff supervision for the remaining residents of the memory care unit.
Plan of Correction:	Responses on the enclosed plan of correction do not constitute an admission or agreement of the truthof the facts alleged or the conclusion set forth in the regulatory report. The responses are prepared solely as amatter of compliance with the law. The facility will ensure to have staff adequate in knowledge, skills, and abilities and sufficient in numbers to provide services to attain and maintain the physical, mental, and psychosocial well being of each resident as determent by resident assessments and individualized service plans. Facility will ensure to provide monitoring, when care is provided to a resident that requires two-person assistance in memory care. HCD will make sure a staff is available to monitor residents if other staff is providing care to residents with two person assistance.
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 #1?s record was reviewed during the inspection. Resident #1?s physical examination form, dated 11/28/21, listed the resident?s allergies. The form did not contain the resident?s reactions to the allergens. Resident #4?s physical examination form, dated 6/23/21, listed the resident?s allergies. The form did not contain the resident?s reactions to the allergens.
Plan of Correction:	Responses on the enclosed plan of correction do not constitute an admission or agreement of the truth of the facts alleged or the conclusion set forth in the regulatory report. The responses are preapared solely as a matter of compliance with law. Sales and HCD have been re-educated to ensure that the physical examination form includes all of the required information. HCD will ensure that the physical examinationform does contain the resident's reactions to the allergens. Executive Director or designee is responsible for the implementation and ongoing compliance with the component of the plan of correction.
Standard #:	22VAC40-73-320-B
Description:	Based on record review, the facility failed to ensure that a tuberculosis risk assessment is completed annually for each resident, as evidenced by the completion of the current screening form published by the Virginia Department of Health or a form consistent with it. Evidence: Resident #3?s record was reviewed during the inspection. The most recent tuberculosis risk assessment, included in Resident #3?s record, was dated 4/12/21. The risk assessment was more than a year old, at the time of the inspection.
Plan of Correction:	HCD or Designee will ensure that a tuberculosis risk assessment is completed annually for each resident, as evidenced by the completion of the current screening form published by the Virginia Department of Health or form consistent with it. The Tuberculosis risk assessment for resident #3 has been updated. The Executive Director or designee will ensure the implementation and on going compliance with the components of this plan of correction.
Standard #:	22VAC40-73-325-B
Description:	Based on record review, the facility failed to ensure that the fall risk rating is reviewed and updated after a resident falls. Evidence: Resident #8?s record contained information about a fall on 5/10/22. Resident #8?s fall risk rating was completed on 3/12/22. No documentation was provided, during the inspection, to indicate that Resident #8?s fall risk rating was reviewed or updated after her fall pm 5/10/22. Resident #12?s record contained information about a fall on 4/17/22. Resident #12 had fall risk ratings that were documented on 1/6/20 and12/24/21. No documentation was provided, during the inspection, to indicate that Resident #12?s fall risk rating was reviewed or updated after his fall on 4/17/22.
Plan of Correction:	Fall risk assessment has been completed for residents #8 and resident # 12. HCD will ensure to review and update fall risk rating after each. Executive Director or designee is responsible for confirming the implementation and ongoing compliance.
Standard #:	22VAC40-73-440-L
Description:	Based on record review, the facility failed to maintain the completed Uniform Assessment Instrument (UAI) in the resident record. Evidence: Resident records were reviewed for Residents #4, #5, and #7. The most recent UAI, included in Resident #5?s record, was dated 12/31/19. UAIs were not included in the records of Residents #4 and #7. Facility assessments had been conducted for Residents #4, #5, and #7 within the past year; however, the assessments were not on a UAI form, and they were not signed by the administrator or the administrator?s designee.
Plan of Correction:	UAI for residents # 4 #5 and #7 have been updated and included in the charts. The assessments for Residents #4, #5 and #7 have been updated on UAI form and they are also signed by the Executive Director. HCD or designee will ensure to maintain the completed UAI in the resident record. Executive Director or designee will ensure to sign UAIs.
Standard #:	22VAC40-73-450-E
Description:	Based on record review, the facility failed to ensure that the individualized service plan (ISP) is signed by the administrator and by the resident or his legal representative. Evidence: Resident #7?s record was reviewed during the inspection. Resident #7?s ISP, dated 7/6/21, was not signed by the resident or his legal representative
Plan of Correction:	ISP for resident #7 has been sent to POA for her signature. HCD or designee will ensure to have ISP signed by the resident or his legal representative.
Standard #:	22VAC40-73-520-I
Description:	Based on documentation and interview, the facility failed to ensure that changes are noted on the activity schedule. Evidence: AL Fitness Fun (6/16/22 ? 10 AM), AL Morning Exercise (6/17/22 ? 10AM), Memory Care Ribbon Dancing (6/17/22 ? 10 AM), and Memory Care Flash Card Fun (6/17/22 ? 10:30 AM) were not observed during the inspection. Facility staff reported that some activities were not held, as there was only one person coordinating the activities during the inspection. The AL and Memory Care activity schedules were not updated to reflect any of the changes.
Plan of Correction:	Life Enrichment Director has been re-educated and coached to ensure that corrections are noted on the activity Calendar every time there was a change in thesctivity schedule. ED or designee is responsible for confirming the implementation and ongoing compliance with the components of this plan of correction.
Standard #:	22VAC40-73-560-E
Description:	Based on observation, the facility failed to keep resident records in a locked area. Evidence: Shortly after 8:30 AM, the second floor nursing station was observed to be unlocked and unattended. Several resident charts were located in the nursing station. Shortly after 8:50 AM, the memory care nursing station was left unlocked and unattended. The nursing office was also left unlocked. The nursing office contained the records of the residents on the memory care unit.
Plan of Correction:	Responses on the enclosed plan of correction do not constitute an admission or agreement of the truth of the facts alleged or the conclusion set forth in the regulatory report. The responses are prepared solely as a matter of compliance with law. The signs are posted in both nursing station to keep all resident records in a locked area. Staff were re-educated. HCD or designee will ensure to keep resident records in a locked area.
Standard #:	22VAC40-73-660-A-1
Description:	Based on observation, the facility failed to ensure that the medication storage area remains locked. Evidence: Shortly after 8:50 AM, the memory care nursing station was left unlocked and unattended. A plastic storage tote of medication was located in the nursing station. The memory care nursing office was also unlocked. Several medication packages were observed in the office.
Plan of Correction:	Responses on the enclosed plan of correction do not constitute an admission of agreement of the truth of the facts alleged or the conclusion set forth in the regulatory report. The responses are prepared solely as a matter of compliance with law. The signs are posted on both Medication Rooms to keep all medication locked at all times. HCD or designee will ensure that the medication storage areas remain locked. Staff were re-educated.
Standard #:	22VAC40-73-680-D
Description:	Based on observation and record review, the facility failed to ensure that medication is administered in accordance with the physician?s instructions and consistent with the standards of practice outlines in the current medication aide curriculum approved by the Virginia Board of Nursing. Evidence: The morning medication administration, for Resident #11, was observed during the inspection. The resident's medication was placed into a pill cup for administration and the medication packages were returned to the cart. Before the medication was administered, the licensing inspector asked about the resident's Pantoprazole, as only one 20mg Pantoprazole tablet was in the pill cup. The order for Resident #11's Pantoprazole, dated 6/1/22, calls for the resident to receive 40mg of Pantoprazole during the medication administration. The June MAR for Resident #3 was reviewed. Resident #3 has her blood sugar (BS) checked three times per day, and the MAR calls for her to receive insulin units (U) based on a sliding scale. Resident #3?s MAR included the following sliding scale for insulin administration: 1U (BS= 200-250), 2U (BS= 251-300), 3U (BS= 301-350), 4U (BS= 351-400) The MAR included the following administration of insulin for Resident #3: 1U (BS= 55) on 6/4/22 at 5 PM 2U (BS= 228) on 6/13/22 at 5 PM 1U (BS= 146) on 6/15/22 at 5 PM May and June MARs were observed for Resident #5. Resident #5 was ordered to receive Augmentin on 5/25/22. Resident #5?s MAR states that the Augmentin was not started until 6/11/22
Plan of Correction:	Med Techs and LPNs will be re-educated to ensure that medications are administered in accordance with the physician's instruction and consistent with the standards of practice outlines inthe current medication aid curriculum approved by the virginia board of nursing. HCD or Designee will perform weekly checks to ensure the accuracy and and ongoing compliance with the components of this plan of correction. Executive Director, or Designee is responsible for confirming the implementation and ongoing compliance. Resident # 5 received Augmentin and a follow up CXR to rule out infection. Results were negative.
Standard #:	22VAC40-73-680-M
Description:	Based on observation and interview, the facility failed to ensure that medications ordered for PRN administration are available and properly stored at the facility. Evidence: PRN Polyethylene Glycol and PRN Senexon-S, ordered 11/16/21 for Resident #3, were not present at the time of the medication cart inspection. A package of PRN Quetiapine 12.5mg, ordered 11/8/21 for Resident #9, was found in the medication cart. The medication expired on 5/7/22. Resident #9 did not have any additional packages of PRN Quetiapine 12.5mg, at the time of the medication cart inspection. PRN Duoneb, ordered 7/26/21 for Resident #10, was not present at the time of the medication cart inspection. PRN Senexon-S, ordered 6/1/22 for Resident #11, was not present at the time of the medication cart inspection. Facility staff confirmed that the PRN medications were not present, at the time of the medication cart inspection.
Plan of Correction:	All PRN medications have been discontinued as per their physician's orders for non useage for more than 90 days. Weekly Medication Carts audits will be performed by med techs to ensure the availabilty of all PRN medications. HCD or designee is responsible for confirming the implementation an ongoing compliance. All Med techs will be provided coaching and training.
Standard #:	22VAC40-73-700-2
Description:	Based on observation, the facility failed to ensure that "No Smoking-Oxygen in Use" signs are posted in any room where oxygen is in use. Evidence: Resident #3's record contained an oxygen order from 5/15/22. Resident #3 was observed using oxygen, but no oxygen notification sign was posted for the resident's room.
Plan of Correction:	The " No Smoking-Oxygen In Use" has been posted for resident #3's apartment. HCD or designee will ensure the comliance by weekly checks.