VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Ashby Ponds, Inc.
21160 Maple Branch Terrace
Ashburn, VA 20147
(571) 291-6210

Current Inspector: Sarah Pearson (540) 680-9469

Inspection Date: April 5, 2023

Complaint Related: No

Areas Reviewed:

22VAC40-73 PERSONNEL 22VAC40-73 RESIDENT CARE AND RELATED SERVICES

Comments:

Type of inspection: Monitoring 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 1:30 pm on 4/5/2023 and exited at 3:45 pm on 4/5/2023. The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. A self-reported incident was received by VDSS Division of Licensing on 3/6/2023, 3/14/2023, and 3/23/2023 regarding allegations in the area(s) of personnel, and resident care and related services. Number of resident records reviewed: 3 Number of staff records reviewed: 3. Number of interviews conducted with residents: 0 Number of interviews conducted with staff: 0 Observations by licensing inspector: Additional Comments/Discussion: An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation supported the self-report of non-compliance with standard(s) or law, and violation(s) were issued. Any violation(s) not related to the self-report 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. 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 #:	22VAC40-73-130-A
Description:	Based upon a review of records, the facility failed to ensure that all staff who are mandated reporters under ? 63.2-1606 of the Code of Virginia shall report suspected abuse, neglect, or exploitation of residents in accordance with that section. Evidence: 1. The facility submitted a self-report to the regional licensing office on 3/14/2023. According to that report, on 3/12/2023 at approximately 8:00pm, Staff #1 was told by Resident #3 that ?she wanted to notify police because another staff member was trying to rape her.? The self-report documents that Staff #1 redirected Resident #3 to engage in one-on-one activities of interest for the rest of the evening. 2. According to the self-report and progress notes Staff #1 did not report the incident that occurred on 3/12/2023 regarding the allegations made by Resident #3 that another staff member was trying to rape her, until 3/14/2023.
Plan of Correction:	1. Staff member identified as Staff #1 who failed to report allegation of abuse, was re-educated on mandated reporting on 3/14/2023. Staff #1 also received written disciplinary action which was completed on 4/11/2023. 2. Comprehensive Staff Education: a. Assisted Living Manager or designee will ensure Assisted Living staff receive education regarding Abuse Prevention, including mandated reporting. b. Nursing Home Administrator or designee will in-service licensed and non-licensed staff on Resident Rights and Abuse Prevention policy including mandated reporting.