VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Paul Spring Independent and Assisted Living Community
7116 Fort Hunt Road
Alexandria, VA 22307
(703) 768-0234

Current Inspector: Nina Wilson (703) 635-6074

Inspection Date: Dec. 29, 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:

An unannounced renewal inspection was conducted on 12/29/22 (8:30 AM - 5:50 PM). At the time of entrance, 153 residents were in care. Meals, medication administration and activities were observed. Building and grounds were inspected and records were reviewed. The sample size consisted of 10 resident records and five staff records. Additional interviews were conducted after the on-site visit. Violations 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. 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 #:	22VAC40-73-550-C
Description:	Based on documentation and interview, the facility failed to ensure that each resident is free of physical restraints, except in the following situations and with appropriate safeguards: 1. As necessary for the facility to respond to unmanageable behavior in an emergency situation, which threatens the immediate safety of the resident or others. 2. As medically necessary, as authorized in writing by a physician, to provide physical support to a weakened resident. Evidence: Staff #7 reported that he was called to assist Staff #6 in the process of providing care for Resident #9, due to the resident?s aggression. Staff #7 reported that he held Resident #9?s wrists, so that Staff #6 could change the resident?s clothing. While trying to provide assistance, Staff #7 reported that he was scratched by Resident #9. After being scratched, Staff #7 reported that he held the residents hands and rocked them back and forth, until Staff #6 could complete the care task. Neither Staff #6, nor Staff #7, reported that the situation was an emergency. Staff #7 reported that he did not have any training for aggressive residents and resident restraints. No facility documentation was provided, during the inspection, to indicate that Staff #7 received training regarding aggressive residents or resident restraints. No restraint orders were observed in the record for Resident #9.
Plan of Correction:	In-person aggressive behavior training in-service will be provided to staff. Audit to be conducted to ensure 100% online Relias compliance.
Standard #:	22VAC40-73-660-B
Description:	Based on observation and record review, the facility failed to limit medication storage to an out-of-sight place in the rooms of residents, whose UAI has indicated that the resident is capable of self-administering medication. The medication and any dietary supplements shall be stored so that they are not accessible to other residents. Evidence: Calmoseptine was observed in the bathroom of Resident #5 of the memory care unit. Resident #5?s record contained an order, dated 2/13/20, for Calmoseptine. Resident #5?s UAI, dated 8/26/22, states that the resident needs assistance for medication administration. Gold Bond medicated powder was observed in the bathroom of Resident #9 of the memory care unit. Resident #9?s UAI, dated 10/21/22, states that the resident needs assistance for medication administration.
Plan of Correction:	All medications will be safely secured, stored, and administered by licensed clinical staff. The Inspiritas Director of Clinical Services and Engagement will conduct routine, unannounced room inspections for monitoring and compliance.
Standard #:	22VAC40-73-680-D
Description:	Based on observation and documentation, the facility failed to ensure that medications are administered 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: The morning medication administration, for Resident #2, was observed during the inspection. Resident #2?s Lisinopril was not administered during the morning medication administration. Resident #2?s Medication Administration Record (MAR) stated that the medication was not given, as the vitals were outside the parameters for administration. Resident #2?s Lisinopril order, dated 9/16/21, does not include any parameters for administration. The MAR stated that Resident #2?s Lisinopril was also held due to vitals being outside of parameters for administration on: 12/5, 12/6, 12/7, 12/10, 12/11, 12/24. The morning medication administration, for Resident #6, was observed during the inspection. Resident #6?s medications were crushed and provided to her, while she was eating breakfast. Included among Resident #6?s medications was Ferrous Sulfate. The medication packaging, for Resident #6?s Ferrous Sulfate, states that the medication should not be crushed and that it should be taken on an empty stomach.
Plan of Correction:	Clinical Services will conduct mandatory training for nurses and Registered Medication Aides regarding medication administration/medication management plan. Clinical administration will conduct routine, unannounced medication administration audits for monitoring and observation.
Standard #:	22VAC40-73-860-I
Description:	Based on observation and record review, the facility failed to ensure that cleaning supplies and other hazardous materials are stored in a locked area. Evidence: Multi-surface cleaner was observed in the cabinet of Resident #5 of the memory care unit. The cleaner was unlocked and unattended. Resident #5?s record contains an Assessment of Serious Cognitive Impairment, dated 7/16/19, that states that the resident has a serious cognitive impairment and that he is unable to recognize danger or protect his own safety and welfare.
Plan of Correction:	Facility will ensure all hazardous materials including cleaning supplies are stored in a locked area on the memory care unit. Administration will conduct routine, unannounced room inspections for monitoring and compliance.