VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Harmony at Chantilly
2980 Centreville Road
Herndon, VA 20171
(703) 994-4561

Current Inspector: Amanda Velasco (703) 397-4587

Inspection Date: Nov. 4, 2022 , Nov. 17, 2022 , Jan. 26, 2023 and March 17, 2023

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 STAFFING AND SUPERVISION 22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-73 BUILDINGS AND GROUND

Comments:

Unannounced complaint inspection were conducted to follow-up on complaints received by the licensing office on 10/3/22, 2/9/23, and 2/28/23 regarding: Staffing and Supervision, Resident Care and Related Services. Medication administration, an activity, and facility documentation were observed. Violations were discussed and an exit meeting was held. 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: October 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. The October schedule listed 31 shifts, when only three direct care staff members are on duty.
Plan of Correction:	Staffing schedule was reviewed and updated to meet the staffing requirements outlined by the state guidelines.
Standard #:	22VAC40-73-450-E
Complaint related:	Yes
Description:	Based on record review, the facility failed to ensure that the individualized service plan (ISP) is signed and dated by the administrator or their designee, and by the resident or his/her legal representative. Evidence: ISPs were observed, during the inspection. Resident #1?s ISP, dated 1/15/23, was not signed by the resident or his legal representative Resident #2?s ISP, dated 11/8/22, was not signed by the resident or her legal representative. Resident #3?s ISP, dated 8/17/22, was not signed by the resident or her legal representative. Resident #4?s ISP, dated 10/5/22, was not signed by the resident or his legal representative.
Plan of Correction:	The facility will ensure that ISPs are signed and dated by the administrator or designee and/or the resident or legal representative.
Standard #:	22VAC40-73-450-H
Complaint related:	Yes
Description:	Based on record review, the facility failed to ensure that personal assistance and care is provided to each resident as necessary so that the needs of the resident are met, including assistance or care with: Bathing ? at least twice a week, but more often if needed or desired. Evidence: The facility?s February shower logs were observed during the inspection. Resident #2?s ISP states that she needs staff assistance for bathing. No information was observed, during the inspection, to document that Resident #2 was bathed in February. Resident #3?s ISP states that she needs staff assistance for bathing. No information was observed, during the inspection, to document that Resident #3 was bathed in February. Resident #4?s ISP states that he needs staff assistance for bathing. No information was observed, during the inspection, to document that Resident #4 was bathed in February.
Plan of Correction:	An inservice was provided to all the direct care staff outlining the importance of documentation and keeping records of all ADLs. Also inserviced on the importance of providing care as outlined by the care plan.
Standard #:	22VAC40-73-520-I
Complaint related:	No
Description:	Based on observation, the facility failed to ensure that the written schedule of activities is updated. If one activity is substituted for another, the change shall be noted on the schedule. Evidence: Residents, in the memory care unit, were observed watching a television game show at 11:22 AM. Cooking show was listed as the activity for 11:00 AM. The activity schedule was not updated to reflect the change that was made.
Plan of Correction:	Facility will ensure that the master schedule of activities is updated and any changes/updates are reflected on the schedule.
Standard #:	22VAC40-73-680-D
Complaint related:	Yes
Description:	Based on documentation, the facility failed to ensure that medications are administered in accordance with the physician's or other prescriber?s instructions and consistent with the standards of practice outlines in the current medication aide curriculum approved by the Virginia Board of Nursing. Evidence: Resident #1?s MARs were observed during the inspection. Resident #1? MAR indicates that he has a sliding scale for Insulin administration. Resident #1?s sliding scale states that he is to receive 1 unit of insulin when his blood sugar (BS) is between 201 and 250. On 2/28/23 (4:30 PM), Resident #1 was given three units of insulin, when the resident?s blood sugar was 247. Resident #1?s insulin order changed in March and he was ordered to receive three units of insulin when his blood sugar (BS) is between 201 and 250, and five units of insulin, when his blood sugar is between 251 and 300. On 3/3/23 (7:30 AM), Resident #1 was administered 13 units of insulin when his blood sugar was 292. On 3/11/23 (11:30 AM), Resident #1 was administered three units of insulin when his blood sugar was 254. Resident #2?s MAR was reviewed during the inspection. Resident #2 was not administered Lorazepam on 2/28/23 (8 AM), as the MAR states the facility was ?awaiting pharmacy.?
Plan of Correction:	Facility will ensure that medications are administered according to physician's order. An inservice was provided to all the MedTech's concerning the standards of practice for the medication aides.