VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Tribute at The Glen
4151 Old Bridge Road
Woodbridge, VA 22192
(571) 402-1870

Current Inspector: Sarah Pearson (540) 680-9469

Inspection Date: Jan. 26, 2023

Complaint Related: No

Areas Reviewed:

Administration and Administrative Services Personnel Staffing and Supervision Admission, Retention and Discharge of Residents Resident Care and Related Services Resident Accommodations and Related Provisions Buildings and Grounds Emergency Preparedness

Comments:

Date of Inspection: 1/26/23, 2/8/2023 Type of Inspection: Monitoring inspection If you have any questions or email changes, please do not hesitate to contact me at sarah.pearson@dss.virginia.gov. If you need a copy of any of the DSS Model forms or to review any inspection or regulation, you can find the information on the internet: www.dss.virginia.gov. Census 81 Number of records reviewed and interviews conducted- 6 records, 8 interviews. All facility self-reported incidents since the last inspection were reviewed on this date. The Licensing Inspector and the Administrator discussed the risk assessment ratings for the violations for this inspection. Please complete the ?plan of correction? and ?date to be corrected? for each violation cited on the violation notice and returned it to the office. You will need to specify how the deficient practice will be or has been corrected. Your plan of correction must contain: 1) steps to correct the noncompliance with the standard(s), 2) measures to prevent the noncompliance from occurring again; and 3) person(s) responsible for implementing each step and/or monitoring any preventive measure(s). The completed corrective action needs to be in the licensing office by February 15, 2023

Violations:

Standard #:	22VAC40-73-650-B
Description:	Based on resident records review and staff interview, it was determined that the facility staff failed to obtain and document complete physician orders. Evidence: Resident B and C's Physician Order Sheets did not contain diagnosis, condition, or specific indication for every currently prescribed medication.
Plan of Correction:	Executive Director designated the Resident Services Director (RN) and Memory Care Director (LPN) to review the Medication Administration Records for all residents to ensure that each prescribed medication has a corresponding diagnosis identified. (Date completed 2/13/2023). a. The Medication Administration Record for Residents B and C was updated to reflect a diagnosis for each medication. b. The Medication Administration Record for all other residents was reviewed and updated as needed to reflect a diagnosis for each medication. c. The Resident Services Director (or designee) will review all new orders to ensure that a diagnosis is listed for each medication.
Standard #:	22VAC40-73-950-E
Description:	Based on record review and staff interview, it was determined that the facility staff failed to conduct an Emergency Preparedness Review with staff semi-annually. Evidence: Facility staff did not have record of Emergency Preparedness Review with staff within the last six months.
Plan of Correction:	1. Executive Director has established a schedule to conduct Emergency Preparedness Review with all staff each year, twice annually, during which the facility's Emergency Preparedness Plan will be reviewed. (date completed 2/22/2023). a. The initial Emergency Preparedness Plan Review for 2023 will take place during All Team Member Meetings in March 2023. b. The second bi-annual review will occur in September 2023. c. The Executive Director (or designee) will review staff roster and training records after each training. Any staff member who has not had training will be contacted to arrange for individual or small group review of the Emergency Preparedness Plan. d. The facility will maintain records of completion of the bi-annual Emergency Preparedness Review for all staff members.