VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Crystal Gardens Assisted Living, LLC
6712 Bostwick Drive
Springfield, VA 22151
(703) 642-5329

Current Inspector: Alexandra Roberts

Inspection Date: May 6, 2022

Complaint Related: No

Areas Reviewed:

22VAC40-73 GENERAL PROVISIONS 22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES2VAC40-73 GENERAL PROVISIONS 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 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 5/6/22. At the time of entrance, three residents were in care. A meal and medication administration were observed. Building and grounds were inspected. Records were reviewed. The sample size consisted of three staff records and three resident records. The violation was 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 #:	22VAC40-73-680-D
Description:	Based on observation and documentation, the facility failed to administer medication in accordance with the physician?s or other prescriber?s instructions and consistent with the standards of practice outlines in the current medication aide curriculum approved by the Virginia Board of Nursing. Evidence: Medication administration for Resident #1 was observed during the inspection. Resident #1 was administered Levothyroxine, while she was eating breakfast. Medication instructions for Resident #1?s Levothyroxine, dated 11/18/21, state that the medication should be given before breakfast. Medication administration for Resident #2 was observed during the inspection. Resident #2?s Pantaprazole was placed in a bowl to be crushed. Before the medication was crushed, the licensing inspector asked about the medication instructions for Resident #2?s Pantaprazole, ordered 8/31/21. The instructions, for Pantaprazole, stated that the medication should not be crushed.
Plan of Correction:	Steps made to correct non-compliance: Will make sure that Resident #1 will take her Levothyroxine before eating her breakfast. Food will not be served before administration of the Levothyroxine, even though she was instructed not to eat first and wait for her meds, resident just started. Resident #2's Pantoprazole was coordinated immediately with the Doctor, that we have an order for crush meds for the Resident, but the bottle was labeled not to crush meds. Measures to prevent the non-compliance from occurring again: Food or Resident #1 will not be served on the table before Levothyroxine is administered. A doctor's order for Resident #2 was received, changing the Pantaprazole to a crushable meds. Person(s) responsible for implementing each step and/or monitoring any preventative measures: -Judy Campanilla, RN, all Medication Aides.