VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Beverly Assisted Living
3408 Beverly Drive
Annandale, VA 22003
(571) 308-3793

Current Inspector: Jacquelyn Kabiri (703) 397-3017

Inspection Date:

Complaint Related: No

Violations:

Standard #:	22VAC40-73-530-A
Description:	Based on observation and interview, the facility failed to ensure that any resident who does not have a serious cognitive impairment is allowed to freely leave the facility. A resident who has a serious cognitive impairment shall be subject to the provisions set forth in 22VAC40-73-1040 A or 22VAC40-73-1150 A. Evidence: Facility staff reported that Resident #3 resides on the first level of the building. The facility?s elevator was not operational, at the time of the inspection. At the time of the inspection, the first level?s exit door was locked. The door had a double-cylinder deadbolt, that would require a key to disengage the lock (whether from the interior or the exterior of the building). At the time of the inspection, Resident #3 was the only resident on the first level of the building. Resident #3 was not able to use the elevator to reach another level of the home, and there was no alternate method to reach the other levels of the building. The only exit door for the first level of the building required a key to disengage the lock. Resident #3's physical exam, 8/25/23, does not indicate that he has a serious cognitive impairment. The facility does not have a special care unit.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-660-A-1
Description:	Based on observation, the facility failed to ensure that the medication storage area remains locked. Evidence: At approximately 11:35 AM, the medication cart was observed to be unlocked and unattended.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-870-I
Description:	Based on documentation and interview, the facility failed to ensure that elevators are inspected at least annually. Evidence: The facility's elevator was not operational, at the time of the inspection. The facility?s administrator reported that an error code was flashing on the elevator's level indicator. No elevator certificate of inspection was provided, to confirm that the elevator had been inspected within the past year.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-950-E
Description:	Based on documentation, the facility failed to implement a semi-annual review on the emergency preparedness and response plan for all staff, residents, and volunteers. Evidence: The last documented review on the emergency preparedness plan, observed during the inspection, was dated 12/15/22. The review as more than six-months old, at the time of the inspection.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-960-B
Description:	Based on observation, the facility failed to ensure that a fire and emergency evacuation drawing is posted in a conspicuous place on each floor of each building used by residents. Evidence: The facility?s fire and emergency evacuation drawing was not posted, in a conspicuous place, on the first or second floor of the building. The facility?s fire and emergency evacuation drawing was observed in three of the eight bedrooms, but no drawing was observed in an area conspicuous to all residents, staff, and visitors.
Plan of Correction:	Not available online. Contact Inspector for more information.