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: May 5, 2023

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-80 COMPLAINT INVESTIGATION

Comments:

An unannounced complaint inspection was conducted on 5/5/23, in response to a complaint received by the licensing office on 5/4/23 regarding: Resident Care and Related Services. Medication records and facility documentation were observed. The violation was 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 #:	22VAC40-73-640-A
Complaint related:	Yes
Description:	Based on record review and interview, the facility failed to implement the medication management plan. Evidence: The facility?s medication management plan states that when a resident arrives with a medication, that all medications are logged in a centrally stored medication log, before being placed in the resident medication storage area. Resident #1 was admitted in January 2023 with orders for several controlled medications. The facility?s medication management plan also states that new narcotic control forms will be created for every narcotic or controlled substance brought into the community. When counting newly received narcotics received in bottles, the bottles must be opened and the medications counted. The new narcotic must also be entered on a centrally stored medication log. The narcotic control form will be completed by the staff member checking the medication into the community. Documentation of Resident #1?s medications were reviewed during the inspection. Facility documentation included sheets of the Controlled Drug Record. Resident #1?s record documented the administration of eachdose of the controlled medication. No signatures, were observed on Resident #1?s controlled drug records, to document that a staff member checked in the resident?s controlled medication and verified the amount of medications received when Resident #1 was admitted. Resident #1 was discharged from the facility in April 2023. Resident #1?s medication release form included a note indicating that oxycodone brought into the community is missing. No documentation was provided, during the inspection, to document that Resident #1?s medication was logged at admission. Facility staff confirmed that Resident #1?s admission medication log was not present, at the time of the inspection.
Plan of Correction:	Not available online. Contact Inspector for more information.