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: April 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 ACCOMODATIONS AND RELATED PROVISIONS 22VAC40-73 BUILDING AND GROUNDS 22VAC40-73 EMERGENCY PREPAREDNESS 2VAC40-73 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 monitoring inspection was conducted on 4/19/22. At the time of entrance, 151 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. Violations were discussed and an exit meeting was held. Areas of non-compliance are identified on the violation notice. Please complete the 'plan of correction' and 'date to be corrected' for each violation cited on the violation notice and return to the licensing office within 10 calendar days. Please specify how the deficient practice will be or has been corrected. Just writing the word 'corrected' is not acceptable. The 'plan of correction' must contain: 1) Steps to correct the non-compliance with the standards, 2) Measures to prevent the non-compliance from occurring again, and 3) Person responsible for implementing each step and/or monitoring any preventative measures. Thank you for your cooperation and if you have any questions, contact me via e-mail at m.massenberg@dss.virginia.gov. Violations:

Violations:

Standard #:	22VAC40-73-1090-A
Description:	Based on record review, the facility failed to ensure that each resident is assessed by an independent clinical psychologist licensed to practice in the Commonwealth or by an independent physician as having a serious cognitive impairment due to a primary psychiatric diagnosis of dementia with an inability to recognize danger or protect his own safety and welfare, prior to his/her admission to the safe, secure environment. Evidence: The record for Resident #1, of the memory care unit, was reviewed during the inspection. Resident #1's physical examination Form, dated 3/19/21, states that the resident does not have a serious cognitive impairment due to a primary psychiatric diagnosis of dementia.
Plan of Correction:	Facility will adhere to pre-admission checklist to ensure that all proper paperwork is obtained prior to the admission of a resident into the facility's safe, secure, environment. Director of Clinical Services will complete admission paperwork audit prior to resident's physical move into the facility to ensure all documents are signed and completed accordingly.
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. Evidence: Preparation H cream and ear wax removal medication was observed to be unlocked and unattended, in the room of Resident #4. Resident #4's UAI, dated 12/14/20, states that the resident needs assistance for medication administration. Similisan Dry Eye relief was observed to be unlocked and unattended, in the room of Resident #11. Resident #11's UAI, dated 4/4/22, 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 Director of Clinical Services and Engagement will conduct routine, unannounced room inspections for monitoring and compliance.
Standard #:	22VAC40-73-710-B
Description:	Based on observation and documentation, the facility failed to ensure that physical restraints are used as a medical/orthopedic restraint for support, according to a physician's written order and with the written consent of the resident or his legal representative or (ii) in an emergency situation after less intrusive interventions have proven insufficient to prevent imminent threat of death or serious physical injury to the resident or others. Evidence: Bed rails were observed on the beds of Residents #3 and #5, of the special care unit. Resident #3 has an order, dated 2/24/22, for side rails for turning and repositioning. When asked to demonstrate the usage of the side rail, Resident #3 refused to demonstrate his ability to independently use the side rails for turning and repositioning. Resident #5 has an order, dated 2/22/22, for side rails for turning and repositioning. When asked to demonstrate the usage of the side rail, Resident #5 did not respond to the request to independently use the side rails for turning and repositioning. Resident #5's record contains a physical examination form, dated 7/10/20, that states that he is unable to recognize danger or protect his own safety and welfare.
Plan of Correction:	Proper orders and required documentation obtained for residents who utilize siderails for turning and repositioning.
Standard #:	22VAC40-73-860-I
Description:	Based on observation, the facility failed to ensure that cleaning supplies and other hazardous materials are stored in a locked area. Evidence: Liquid laundry detergent was observed to be unlocked and unattended in the room of Resident #5, of the memory care unit.
Plan of Correction:	Facility will ensure all hazardous cleaning supplies and other hazardous materials are stored in a locked area. The Director of Clinical Services and Engagement and Environmental Services Director will conduct routine, unannounced room inspections for monitoring and compliance.