VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Crystal Gardens Assisted Living, LLC
6712 Bostwick Drive
Springfield, VA 22151
(703) 642-5329

Current Inspector: Alexandra Roberts

Inspection Date: Nov. 1, 2023

Complaint Related: No

Areas Reviewed:

22VAC40-73 GENERAL PROVISIONS 22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES 22VAC40-73 PERSONNEL 22VAC40-73 STAFFING AND SUPERVISION 22VAC40-73 ADMISSION, RETENTION AND DISCHARGE OF RESIDENTS 22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-73 RESIDENT ACCOMMODATIONS AND RELATED PROVISIONS 22VAC40-73 BUILDINGS AND GROUND 22VAC40-73 EMERGENCY PREPAREDNESS 63.2 GENERAL PROVISIONS 63.2 PROTECTION OF ADULTS AND REPORTING 63.2 LICENSURE AND REGISTRATION PROCEDURES 63.2 FACILITIES AND PROGRAMS 22VAC40-90 BACKGROUND CHECKS FOR ASSISTED LIVING FACILITIES 22VAC40-90 THE SWORN STATEMENT OR AFFIRMATION 22VAC40-90 THE CRIMINAL HISTORY RECORD REPORT 22VAC40-80 THE LICENSE 22VAC40-80 THE LICENSING PROCESS

Comments:

Type of inspection: Mandated Date(s) of inspection: 11/01/2023 Number of residents present at the facility at the beginning of the inspection: Five The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: Three Number of staff records reviewed: Two Number of interviews conducted with residents: Two Number of interviews conducted with staff: Two Observations by licensing inspector: Breakfast, Medication Additional Comments/Discussion: An exit meeting was held. The evidence gathered during the inspection determined no violations with applicable standard(s) or law. 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.