Click Here for Additional Resources
Search for an Assisted Living Facility
|Return to Search Results | New Search |

Tribute at One Loudoun, LLC
20335 Savin Hill Drive
Ashburn, VA 20147
(571) 252-8292

Current Inspector: Laura Lunceford (540) 219-9264

Inspection Date: Feb. 7, 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 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
ARTICLE 1 ? SUBJECTIVITY
32.1 REPORTED BY PERSONS OTHER THAN PHYSICIANS
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

Technical Assistance:
A completed Renewal Application must be submitted prior to the expiration of the current license. The facility should receive an application in the mail, however if an application has not been received one can be obtained from the DSS web site or by calling the main office at (276) 206-0492.

Comments:
Type of inspection: Renewal
Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: LI entered the facility at 8:55 am on 2/7/2023 and exited at 5:00 pm on 2/7/2023.
The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection.
Number of residents present at the facility at the beginning of the inspection: 96
The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility.
Number of resident records reviewed: 10 plus 2 discharged resident records
Number of staff records reviewed: 5
Number of interviews conducted with residents: 0
Number of interviews conducted with staff: 0
Observations by licensing inspector: LI observed medication administration. LI observed residents eating breakfast and lunch.
Additional Comments/Discussion:

An exit meeting will be conducted to review the inspection findings.

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.

Compliance with all applicable regulations and law shall be maintained and any areas of noncompliance must be corrected.

Within 15 calendar days of your receipt of the inspection findings (inspection summary, violation notice, and supplemental information), you may request a review and discussion of these findings with the inspector's immediate supervisor. To make a request for review and discussion, you must contact the licensing supervisor at the regional licensing office that serves your geographical area.

Regardless of whether a supervisory review has been requested, the results of the inspection will be posted to the DSS public website within 5 business days of your receipt of the Inspection Summary and/ or Violation Notice.

The department's inspection findings are subject to public disclosure.

Please Note: A copy of the findings of the most recent inspection are required to be posted on the premises of the facility.

For more information about the VDSS Licensing Programs, please visit: www.dss.virginia.gov

Should you have any questions, please contact Jamie Eddy, Licensing Inspector at (703) 479-5247 or by email at jamie.eddy@dss.virginia.gov

Violations:
Standard #: 22VAC40-73-260-A
Description: Based upon a review of records, the facility failed to ensure that each direct care staff member who does not have current certification in first aid shall receive certification in first aid within 60 days of employment.
Evidence: According to the staff record, Staff #3 was hired as a care partner on 6/27/2022. There was no documentation of certification in first aid only certification in CPR (cardiopulmonary resuscitation).

Plan of Correction: It is duly noted that the community did not ensure that staff #3 has a current First Aid (FA) certification. Before staff #3 can work again she will need to provide proof of FA certification. Acting Business Office Director (BOD) will audit and ensure all staff has the required FA training by 2/20/2023. All future staff will be required to show proof of FA within 60 days of hire.

Standard #: 22VAC40-73-720-A
Description: Based upon a review of records, the facility failed to ensure that the written order for Do Not Resuscitate (DNR) is included in the Individualized Service Plan (ISP).
Evidence: The ISP for Resident #9 contained in the record does not include the DNR order.

Plan of Correction: It is duly noted that Resident #9?s Care Plan did not address the DNR (Do Not Resuscitate) order. Nursing staff will update Care Plan to include the DNR status by 2/20/2023. Nursing will audit all care plans of all residents who are DNR to ensure the DNR is addressed in the Care Plan by 2/21/2023. Nursing will ensure that all future Residents or current Residents who have an order for DNR will be addressed on the Care Plan.

Standard #: 22VAC40-73-840-B
Description: Based upon a review of pet records the facility failed to ensure that pets living on the assisted living premises shall have regular examinations and immunizations, appropriate for the species, by a licensed veterinarian.
Evidence: The record for Pet #3 indicated that a rabies vaccination was due 7/26/2022. There was no documentation of an updated rabies vaccination in the record.

Plan of Correction: It is duly noted that Pet #3 did not have the required documentation of up-to-date immunization. Pet #3?s family will obtain documentation by 2/25/2023. All future Pets will maintain documentation of immunization

Disclaimer:
This information is provided by the Virginia Department of Social Services, which neither endorses any facility nor guarantees that the information is complete. It should not be used as the sole source in evaluating and/or selecting a facility.

Google Translate Logo
×
TTY/TTD

(deaf or hard-of-hearing):

(800) 828-1120, or 711

Top