VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Tribute at One Loudoun, LLC
20335 Savin Hill Drive
Ashburn, VA 20147
(571) 252-8292

Current Inspector: Amanda Velasco (703) 397-4587

Inspection Date: Jan. 14, 2025 and Jan. 29, 2025

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES 22VAC40-73 STAFFING AND SUPERVISION 22VAC40-73 BUILDINGS AND GROUND 22VAC40-73 EMERGENCY PREPAREDNESS

Technical Assistance:

N/A

Comments:

Type of inspection: Complaint A complaint was received by VDSS Division of Licensing on 01/07/2025 regarding allegations in the area(s) of: 1. Administration and Administrative Services 2. Staffing and Supervision 3. Buildings and Grounds. Date of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 01/14/2025 9:20 AM to 9:35 AM 01/29/2025 9:30 AM 10:50 AM The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. Number of residents present at the facility at the beginning of the inspection: 107 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 0 Number of staff records reviewed: 0 Number of interviews conducted with residents: 0 Number of interviews conducted with staff: 3 Observations by licensing inspector: Postings and/or Visitor Guidance, Cleaning Supplies/ Protocol Additional Comments/Discussion: N/A An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation supported some, but not all the allegations; area(s) of non-compliance with standard(s) or law were Administration and Administrative Services. A violation notice was 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. 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 Amanda Velasco, Licensing Inspector at (703) 397-4587 or by email at Amanda.Velasco@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-100-A
Complaint related:	Yes
Description:	Based on facility document review and staff interview, the facility failed to ensure that the developed infection control program was implemented. Evidence: 1. On 01/02/2025, Staff 1 reported a gastrointestinal outbreak via email to the LI. 2. On 01/29/2025, the LI requested a copy of the infection control program. Number 2 of the facility?s infection control program under ?Infection Control 20 ? Gastrointestinal Illness/Norovirus states the following ?Upon a suspected GI Illness outbreak, the following notification steps are taken?Contact the appropriate county health department for guidance. 3. In an interview with the LI on 01/14/2025, Staff 1 confirmed that they had switched to disposable serving ware and contacted the health department for guidance. 4. In an interview with the LI on 01/29/2025, Staff 1 stated that the health department approved their current protocol that was being implemented. 5. Number 5 of the facility?s infection control program under ?Infection Control 20 ? Gastrointestinal Illness/Norovirus?, the policy states ?Upon a suspected outbreak of GI Illness, the following measures are taken ?f) After receiving approval from the Administrator/Executive Director, the following should be implemented until at least 48 hours AFTER the symptoms in all members of the Community have resolved: i) Cancel all group activities. ii) Close the dining services and implement room delivery on disposable ware?? 6. In an interview with the LI on 01/29/2025, Staff 1 stated that they did not cancel all group activities and close the dining services because that was not discussed with the health department. Staff 1 confirmed that their policy states to cancel all group activities and close the dining service if there is a suspected outbreak. 7. Number 4-A of the facility?s infection control program under ?Infection Control 29 ? Reporting of Infectious Disease/Outbreak? states ??the Community will follow any recommendations by the epidemiologist at the local health department to control the outbreak. The Community will document all actions taken.? 8. In an interview with the LI on 01/29/2025, the facility stated that the guidance given was discussed verbally and confirmed that the actions taken were not documented.
Plan of Correction:	The community will follow the established corporate approved Infection Control Plan. All staff will be in serviced on the Infection Control Plan upon hire and annual thereafter. The Infection Control Plan will be reviewed annually by the corporate qualified designee.