VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Renaissance of Annandale
7112 Braddock Road
Annandale, VA 22003
(703) 256-2525

Current Inspector: Sarah Pearson (540) 680-9469

Inspection Date: Sept. 27, 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 Building and Grounds Emergency Preparedness Additional Requirements for Facilities that Care for Adults with Cognitive Impairments Background Checks for Assisted Living Facilities Sworn Statement

Comments:

Date of Inspection: September 27 & 28, 2023 Type of Inspection: Renewal inspection Census 45 Number of records reviewed and interviews conducted- 8 records, 5 interviews. All facility self-reported incidents since the last inspection were reviewed on this date. The LI observed residents participating in activity programs and eating lunch. Licensing Inspector also observed medication administration and inspected the medication cart. 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. 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 October 17, 2023

Violations:

Standard #:	22VAC40-73-1100-A
Description:	Facility staff failed to complete written approval for placement in a Special Care Unit for residents prior to moving into the unit. Evidence: Res A's approval was completed after the resident moved into the Special Care Unit, Res B's written approval was not completed or signed by facility staff and Res C's was not completed.
Plan of Correction:	1. Corrective action for resident: Completed Residents A, B and C's Special Care Unit Form. 2. Identifying other residents: An audit of all residents completed and updating forms as needed. Audit completed on 10/6/23 and all residents forms were updated as needed. 3. Systemic changes: Process to complete Special Care Unit Form at semi-annual care conference and a binder to review forms for all residents monthly was created. 4. Monitoring corrective actions: The Resident Care Director, or designated person will audit the forms monthly until compliance is met. The results of this audit will be reported during the QA Committee meeting monthly x 3 months for review and recommendations. 5. Date correction action completed: The community's date of alleged compliance is November 17, 2023.