VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Vienna Manor I, LLC
2151 Chain Bridge Road
Vienna, VA 22182
(703) 938-7080

Current Inspector: Alexandra Roberts

Inspection Date: Jan. 20, 2023

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 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 1/20/23 (7:40 AM ? 12:15 PM). At the time of entrance, seven residents were in care. A meal and an activity were observed. Building and grounds were inspected and records were reviewed. The sample size consisted of four resident records and three staff records. 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 #:	22VAC40-73-290-B
Description:	Based on observation, the facility failed to implement a procedure for posting the name of the current on-site person in charge. Evidence: Facility postings were observed upon the inspector?s arrival at the facility. The name of the current on-site person in charge was not posted, at the time of the initial facility walkthrough.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-860-I
Description:	Based on observation, the facility failed to ensure that cleaning supplies and other hazardous materials are in a locked area. Evidence: Disinfectant spray was observed to be unlocked and unattended in a laundry room cabinet.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-880-B
Description:	Based on observation, the facility failed to ensure that the use of portable heating units are only used to provide or supplement heat in the event of a power failure or similar emergency. Evidence: A portable heater was observed to be in use, in the room of Resident #1. No power failure or similar emergency was reported or observed.
Plan of Correction:	Not available online. Contact Inspector for more information.