VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Harmony at Spring Hill
8350 Mountain Larkspur Drive
Fairfax, VA 22079
(571) 348-4970

Current Inspector: Amanda Velasco (703) 397-4587

Inspection Date: March 8, 2023 and March 9, 2023

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 STAFFING AND SUPERVISION 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: 3/8/23 (7:48 AM ? 5:50 PM), 3/9/23 (8:20 AM ? 3:15 PM) The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. A complaint was received by the licensing office on 2/22/23 regarding: Staffing and Supervision and Resident Care and Related Services. The evidence gathered during the investigation supported the allegation of non-compliance with standard(s) or law, and violation(s) were issued. Any violation(s) 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 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 #:	22VAC40-73-280-A
Complaint related:	Yes
Description:	Based on documentation and interview, the facility failed to have staff sufficient in numbers to provide services to attain and maintain the physical, mental, and psychosocial well-being of each resident as determined by resident assessments and individualized service plans, and to ensure compliance with this chapter. Evidence: Facility schedules and punch reports were reviewed during the inspection. The facility has assisted living residents that require the assistance of more than one staff member for ADLs, and a memory care unit with a census larger than five residents. On 2/26/23, only three staff members were observed on the facility punch reports, from the facility schedule, to start the 3-11 shift (Staff #1, Staff #2, and Staff #3). Staff #4 was scheduled to work, but she was not documented on the facility punch reports. Two staff members from the 7-3 shift (Staff #7 and Staff #8), remained on duty until approximately 3:32 PM. Facility staff reported that Staff #5 replaced her on the shift, but she did not punch in until 6:43 PM. On 2/26/23, Staff #5 and Staff #6 were the only staff members in the building, awake and on duty, from approximately 11:06 PM until approximately 11:29 PM (according to facility punch reports).
Plan of Correction:	The appropriate number of direct care staff members will be scheduled for all three shifts. Staff at the community shall meet the requirements per DSS guidelines. The AL resident that required the assistance of more than one staff member is currently no longer residing at the facility. HCD or designee shall review the payroll system to ensure ongoing compliance and present findings monthly at QAPI until 6/30/23.