VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Arden Courts (Fair Oaks)
12469 Route 50
Fairfax, VA 22033
(703) 383-0060

Current Inspector: Jacquelyn Kabiri (703) 397-3017

Inspection Date: Dec. 1, 2022 and Jan. 9, 2023

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 PERSONNEL 22VAC40-73 RESIDENT CARE AND RELATED SERVICES

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: 12/1/22 (8:30 AM - 7:10 PM), 1/9/23 (3:50 PM - 5:45 PM) The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. A complaint was received by VDSS Division of Licensing on 11/7/22 regarding allegations in the area of: Resident Care and Related Services. The evidence gathered during the investigation supported the allegation of non-compliance with standards or law, and violations were issued. Any violations 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 violations will be addressed in order to return the facility to compliance and maintain future compliance with applicable standards 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 #:	22VAC40-73-220-A
Complaint related:	Yes
Description:	Based on record review, the facility failed to ensure that all requirements are met, when private duty personnel from licensed home care organizations provide direct care or companion services to residents in an assisted living facility. Evidence: Facility notes, dated 10/7/22, state that Resident #1: was very aggressive, that he hit staff, threw items, tried to walk by himself and almost fell several times, needs a one to one sitter and that ?he is not safe for all.? Another note states that Resident #1?s wife was contacted and informed that the resident needs a 24 hour caregiver to monitor him closely due to high falls. A facility note, indicates that Resident #1?s private duty aide witnessed his fall on 10/9/22. Facility documentation indicated that the private duty aide was a companion. Facility documentation states that companions are not licensed and do not provide direct nursing care services for the resident. An incident document indicated that the private duty aide spent time monitoring the resident from the hallway, as she was feeling unsafe due to Resident #1?s disorientation and aggression. The document indicated that the aide fed Resident #1 some of an egg, and that he lunged from his bed and fell on his belly. Facility documentation indicates that a physician observed Resident #1 to have a black eye, and gave an order for Resident #1 to be sent to the ER because the resident was not taking medication or eating. Facility documentation indicated that Resident #1 did not return to the facility, and that he passed away on 10/10/22. No documentation was included in the resident record, or provided during the inspection, that lists the type and frequency of services to be delivered to Resident #1 by private duty personnel or a review to determine if the services were acceptable. No documentation was included in the resident record, or provided during the inspection, that indicates that Resident #1?s private duty aide received orientation and training regarding the facility?s policies and procedures related to the duties of private duty personnel.
Plan of Correction:	ASC and/or designee will ensure that all private duty personnel from licensed home care organizations provide direct care or companion services to residents. Before direct care or companion services are initiated, the facility shall obtain, in writing, information on the type and frequency of the services to be delivered to the resident by private duty personnel, review the information to determine if it is acceptable, and provide notification to the home care organization regarding any needed change and the direct care or companion services provided by private duty personnel to meet identified needs shall be reflected on the resident's individualized service plan. New ED started on 10/12/22.
Standard #:	22VAC40-73-440-D
Complaint related:	No
Description:	Based on record review, the facility failed to ensure that uniform assessment instrument (UAI) is completed as required. Evidence: Resident #1?s UAI, signed 10/5/22, was not complete. Resident #1 was assessed as needing assistance with eating, but the type of assistance was not documented. Resident #1 was assessed as being abusive/aggressive/disruptive ? less than weekly, but the type of inappropriate behavior was not documented. Resident #1 was assessed as being disoriented ? some spheres/some of the time, but the affected spheres were not documented. Resident #1?s UAI was completed by a facility employee, but the UAI was not signed/approved by the facility?s administrator or designee.
Plan of Correction:	Executive Director, RSC and/or designee will ensure that all new residents have completed UAI?s and accurate based on their individual needs upon admission. New ED started on 10/12/22.
Standard #:	22VAC40-73-450-A
Complaint related:	Yes
Description:	Based on record review, the facility failed to ensure that on or within seven days prior to the day of admission, a preliminary plan of care is developed in conjunction with the resident, and, as appropriate, other individuals. The preliminary plan shall be identified as such and be signed and dated by the administrator or their designee, and by the resident or their legal representative. Evidence: Facility notes state that Resident #1 was admitted on 10/6/22. No documentation was included in the resident record, or provided during the inspection, that was identified as Resident #1?s preliminary plan of care. Resident #1?s record contained an evaluation of Resident #1?s needs for assistance, but this was not identified as a preliminary plan of care and it was not signed by the resident or his legal representative.
Plan of Correction:	ED and/or designee will ensure that all Resident?s Individualized Service Plans (ISP) are complete, current, and accurate based on their individual needs on or within seven days prior to their admission, and placed in Resident?s medical records. New ED started on 10/12/22.
Standard #:	22VAC40-73-640-A
Complaint related:	Yes
Description:	Based on record review, the facility failed to implement the medication management plan. Evidence: Resident #1?s record was observed during the inspection. Facility notes, dated 10/7/22 and 10/9/22, state that PRN Ativan was administered to Resident #1. No medication administration records (MARs) were included in the resident record.
Plan of Correction:	RSC and/or designee will ensure that all residents have medication administration records in the resident records. New ED started on 10/12/22.