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Heatherwood Independent and Assisted Living
9642 Burke Lake Road
Burke, VA 22015
(703) 425-1698

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

Inspection Date: May 19, 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
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:
Documentation was discussed with the provider.

Comments:
Type of inspection: Renewal
Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 5/19/22 (8:45 AM ? 6:25 PM)
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: 94
The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility.
Number of resident records reviewed: 10
Number of staff records reviewed: 5
Number of interviews conducted with residents: 4
Number of interviews conducted with staff: N/A
Observations by licensing inspector: N/A
Additional Comments/Discussion: N/A

An exit meeting will be conducted to review the inspection findings.

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.

If the licensee wishes to provide a plan of correction: (i) type the plan on a separate Word document, (ii) identify the standard violation number being addressed, (iii) include the date the violation will be corrected, (IV) do not include any names or confidential information, and (V) return to the licensing inspector by email within five (5) business days of the exit interview.

Compliance with all applicable regulations and law shall be maintained and any areas of noncompliance must be corrected.

Within 15 calendar days of your receipt of the inspection findings (inspection summary, violation notice, and supplemental information), you may request a review and discussion of these findings with the inspector's immediate supervisor. To make a request for review and discussion, you must contact the licensing supervisor at the regional licensing office that serves your geographical area.

Regardless of whether a supervisory review has been requested, the results of the inspection will be posted to the DSS public website within 5 business days of your receipt of the Inspection Summary and/ or Violation Notice.

The department's inspection findings are subject to public disclosure.

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 #: 22VAC40-73-450-E
Description: Based on record review, the facility failed to ensure that the individualized service plan is signed and dated by the resident or her legal representative.
Evidence: The record for Resident #9 was reviewed during the inspection. The most recent ISP included in the resident record was dated 5/12/20. Facility staff provided an updated ISP that was completed on 10/1/21. The ISP, dated 10/1/21, was not signed by Resident #9 or her legal representative.

Plan of Correction: Not available online. Contact Inspector for more information.

Standard #: 22VAC40-73-660-B
Description: Based on observation and record review, the facility failed to ensure that medication storage is limited to an out-of-sight place, in the rooms of residents whose UAI has indicated that the resident is capable of self-administering medication.
Evidence: Antacid was observed on the table in the room of Resident #7. Resident #7?s UAI, dated 6/3/21, states that the resident needs her medications to be administered/monitored by professional nursing staff.

Plan of Correction: Not available online. Contact Inspector for more information.

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 Saline Spray, ordered 5/27/19 for Resident #7, was not present at the time of the medication cart inspection. Staff #2 reported that the Saline Spray has been ordered, but it has not arrived yet.

Plan of Correction: Not available online. Contact Inspector for more information.

Standard #: 22VAC40-73-860-C
Description: Based on observation, the facility failed to ensure that plans are submitted to the department for review, before construction begins.
Evidence: During the inspection, a portion of the first floor was observed to be under construction.The floor plans, observed in the construction area, indicated that the space was going to be converted into a memory care unit. The plans had not been submitted to the licensing office, before construction began.

Plan of Correction: Not available online. Contact Inspector for more information.

Standard #: 22VAC40-90-40-B
Description: Based on record review, the facility failed to obtain a criminal history record report, from the Department of State Police, within 30 days of hiring an employee.
Evidence: The criminal history record reports, of new staff members, were reviewed during the inspection. The criminal history report for Staff #6, hired 10/11/21, was obtained on 2/15/22. The criminal history report for Staff #7, hired 9/27/21, was not provided during the inspection. Staff #7?s criminal history request form was dated 9/28/21, but the results were not present at the time of the inspection.

Plan of Correction: Not available online. Contact Inspector for more information.

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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