VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Avalon House on Woodland Drive
6809 Woodland Drive
Falls church, VA 22046
(301) 656-8823

Current Inspector: Amanda Velasco (703) 397-4587

Inspection Date: April 10, 2025

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- (1) GENERAL PROVISIONS 22VAC40-90 BACKGROUND CHECKS FOR ASSISTED LIVING FACILITIES 22VAC40-90 THE SWORN STATEMENT OR AFFIRMATION

Technical Assistance:

Restraints Gates on Stairs- Administrator will be confirming with local fire officials on continued use. 290-A: Ensure shift times are listed on schedule.

Comments:

Type of inspection: Renewal Date of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 04/10/2025 9:15 AM to 1:00 PM 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: 8 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 3 Number of staff records reviewed: 2 Number of interviews conducted with residents: 0 Number of interviews conducted with staff: 4 Observations by licensing inspector: Meals, Activities, Medication Pass and Medication Storage Audit Additional Comments/Discussion: N/A An exit meeting will be conducted to review the inspection findings. The evidence gathered during the inspection determined non-compliance with applicable standard(s) or law, and violation(s) were documented on the violation notice issued to the facility. 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 #:	22VAC40-73-530-B
Description:	Based on direct observation and staff interview, the facility failed to ensure that doors leading to the outside are not locked from the inside or secured in any manner that amounts to a lock. Evidence: 1. On 4/10/2025, the LI observed three locked doors in the facility including the front door, back door, and side door that leads to the driveway. The front door and back door had double locks including a deadbolt with a thumb turn and a sliding security bolt at the top of the door. Both doors also had a keypad to disarm the door alarms. 2. During a tour of the facility, the LI observed staff 4 unlock both locks and disarm the door alarm to let the LI go outside. When the LI returned inside, staff 4 locked the door again. 3. The LI requested a demonstration of the door locks and alarms. Staff 3 stated that the keypad did not lock the door, only armed or disarmed the door alarm. 4. In an interview with the LI, staff 1 confirmed that the doors should have been unlocked. 5. Photo evidence obtained.
Plan of Correction:	Locks & deadbolts will be taken off of all doors leading to the outside and shall not be locked from the inside. Staff have been retrained about the locks on all outgoing doors
Standard #:	22VAC40-73-610-B
Description:	Based on direct observation, facility document review, and staff interview, the facility failed to ensure that the menu for meals and snacks was posted and dated. Evidence: 1. On 04/20/2025, the LI observed the posted weekly menu that was dated ?April 2025?. The menu did not include snacks. 2. In an interview with the LI, Staff 1 acknowledged that the menu did not include snacks. 3. Photo evidence obtained.
Plan of Correction:	A snack menu has been posted next to the menu posted on the bulletin board by the administrator.
Standard #:	22VAC40-73-860-I
Description:	Based on direct observation and staff interview, the facility failed to ensure cleaning supplies and other hazardous items were stored in a locked area. Evidence: 1. On 4/10/2025, the LI observed the bathroom on the first level with the door open. Inside the bathroom, the cabinet door was unlocked and contained various cleaning products including nine spray bottles and one-gallon sized jug. 2. In an interview with the LI on 04/10/2025, Staff 1 acknowledged that the cabinet was unlocked and contained cleaning products. 3. Photo evidence obtained.
Plan of Correction:	Administrator has retrained direct facility direct care staff & managers that cleaning supplies shall be kept locked up. Administrator provided an appropriate lock to ensure the bathroom cabinet where they were stored will be kept locked. Facility manager and administrator will do spot checks to ensure locks where cleaning supplies are kept are in working or and report to the management team if new locks are needed or need to be replaced.
Standard #:	22VAC40-73-870-A
Description:	Based on direct observation, and staff interview, the facility failed to ensure that the interior and exterior of all buildings was maintained in good repair. Evidence: 1. On 04/10/2025, the LI observed the following items in need of repair or replacement: a. The screen to the left of the door had multiple holes. b. The pavers/ walkway stones leading to the back patio area were broken and wobbly. c. The door to the bathroom had a hole in the door. d. A closet doorframe had multiple cracks and splinters. e. The patio furniture (outdoors) was cracked, broken, and missing pads, f. The cabinet doors in the kitchen were off the hinges. 2. In an interview with the LI on 04/10/2025, Staff 1 confirmed that maintenance was needed. 3. Photo evidence obtained.
Plan of Correction:	Facility has arranged with a handyman to do the following: a. Fix or replace any torn or missing screens from windows b. Repair or replace any broken or wobbly paver/walkway stones leading to the back patio c. Replace the door to the bathroom that has a hole d. Repair the doorframe to the closet with cracks e. Repair or replace the cabinets doors in the kitchen off of their hinges Management team will replace any patio furniture that is cracked, or broken. Any furniture needing pads, will be replaced. Facility Manager & administrator will do spot checks and report any item needing to be repaired to the management team.