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: Nov. 10, 2022 , Dec. 13, 2022 and Dec. 14, 2022

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 STAFFING AND SUPERVISION 22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS

Comments:

Type of inspection: Complaint Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 11/10/22 (8:30 AM - 6:10 PM), 12/13/22 (8:15 AM - 6:45 PM), 12/14/22 (7:45 AM - 4:50 PM). The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. A complaint was received by the licensing office on 10/5/22 regarding: Staffing and Supervision and Resident Care and Related Services. The evidence gathered during the investigation supported the allegation of non-compliance with standard(s) or law, and violation(s) were issued. Any violation(s) not related to the complaint but identified during the course of the investigation can also 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. 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 #:	22VAC40-73-280-A
Complaint related:	Yes
Description:	Based on documentation, the facility failed to have staff 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: Facility schedules and punch reports were reviewed during the inspection. The facility has assisted living residents that require the assistance of more than one staff member for ADLs, and a memory care unit with a census larger than five residents. The facility schedule lists Staff #s 1-4 for the night shift (11 PM ? 7 AM) on 10/14/22. Staff punch reports indicate that Staff #4 punched out at 12:44 AM and punched back in at 1:19 AM. During Staff #4?s break period, the facility only had three staff members on duty. The facility schedule lists only Staff #s 2,4, and 5, for the night shift on 10/26/22. The names of any additional staff members that worked during the shift, were not provided during the inspection. The facility schedule lists Staff #s 2,3,4, and 6, for the night shift on 10/28/22. The schedule has Staff #3?s name crossed out. No other staff member was documented to substitute for Staff #3. The names of any other staff members that worked during the shift, were not provided during the inspection. Facility documents indicate that Staff #6 punched out at 1 AM on 10/29/22 and returned to work at 1:30 AM. During Staff #6?s break period, the facility only had two documented staff members on duty. The facility schedule lists only Staff #s 1,2, and 5, for the night shift on 10/30/22. The schedule noted that Staff #1 was substituting for Staff #6. The names of any additional staff members that worked during the shift, were not provided during the inspection.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-290-A
Complaint related:	No
Description:	Based on documentation, the facility failed to maintain a written work schedule that includes the names and job classifications of all staff working on each shift, with an indication of whomever is in charge at any given time. Any absences, substitutions, or other changes shall be noted on the schedule. Evidence: The facility schedule lists Staff #s 4,6,7, and 8, for the night shift on 10/31/22. The schedule noted that Staff #7 was substituting for Staff #2. Facility punch reports were reviewed, and there was no record of Staff #8 working on the night shift on 10/31/22. The facility schedule listed Staff #3 as being sick on 10/30/22 and 10/31/22, and she was not scheduled for work on those days. The punch report indicated that Staff #3 worked on the night shift on 10/31/22. No change was made to the schedule to note that Staff #3 would be working.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-450-A
Complaint related:	Yes
Description:	Based on record review, the facility failed to ensure that a preliminary plan of care is developed to address the basic needs of the resident, on or within seven days prior to the day of admission. The preliminary plan shall be identified as such and be signed and dated by the administrator, or his designee, and by the resident or their legal representative. Evidence: The record of Resident #1 was observed during the inspection. Resident #1 was admitted to the facility on 10/30/22. No plan of care was provided for Resident #1, during the inspection.
Plan of Correction:	Not available online. Contact Inspector for more information.