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Ashby Ponds, Inc.
21160 Maple Branch Terrace
Ashburn, VA 20147
(571) 291-6210

Current Inspector: Sarah Pearson (540) 680-9469

Inspection Date: Sept. 6, 2022

Complaint Related: No

Areas Reviewed:
22VAC40-73 RESIDENT CARE AND RELATED SERVICES

Comments:
Type of inspection: Monitoring
Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: LI entered the facility on 9/6/2022 at 10:20 am and exited the building at 1:05 pm on 9/6/2022.
The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection.
A self-reported incident was received by the VDSS Division of Licensing on 8/25/2022 and 9/3/2022 regarding allegations in the area(s) of: resident care and related services.

Number of residents present at the facility at the beginning of the inspection: 93
Number of resident records reviewed: 2
Number of staff records reviewed: 1
Number of interviews conducted with residents: 0
Number of interviews conducted with staff: 2
Observations by licensing inspector:
Additional Comments/Discussion:

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

The evidence gathered during the investigation did not support the self-report of non-compliance with standard(s) or law. However, violation(s) not related to the self-report but identified during the course of the investigation can be found on the violation notice. 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 Jamie Eddy, Licensing Inspector at (703) 479-5247 or by email at jamie.eddy@dss.virginia.gov

Violations:
Standard #: 22VAC40-73-40-A
Description: Based upon a review of records and interviews, the facility failed to ensure compliance with the facility?s own policies and procedures.
Evidence: According to the facility?s abuse prevention policies and procedures, all employees are required to immediately report suspected or alleged incidents of apparent abuse, neglect, exploitation or mistreatment involving injuries of unknown source and misappropriation of resident property to his or her immediate supervisor and/or team leader. Staff Interview #1 conducted on 9/6/2022 revealed that four staff members were disciplined for failing to report alleged verbal abuse of a resident by a fellow staff member. A review of records revealed that on 8/12/2022 staff members witnessed alleged verbal abuse of a resident by a fellow staff member, but a report of the alleged abuse was not reported to the supervisor or team leader until 8/25/2022.

Plan of Correction: 1. Four staff members identified as failing to report alleged verbal abuse will receive written disciplinary action. Completed 9/12/2022.

2. Comprehensive Staff education:
a. Memory Care Manager or designee will ensure Memory Care staff receive education regarding Abuse Prevention, including mandated reporting. Completed 9/3/2022.
b. Nursing Home Administrator or designee will in-service licensed and non-licensed staff on Resident Rights and Abuse Prevention policy including mandated reporting. Completion by 11/18/2022.

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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