VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Sunrise of Fairfax
9207 Arlington Boulevard
Fairfax, VA 22031
(703) 691-0046

Current Inspector: Marshall Massenberg (804) 543-5188

Inspection Date: April 23, 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 GROUNDS 22VAC40-73 EMERGENCY PREPAREDNESS 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS ARTICLE 1 - SUBJECTIVITY 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

Technical Assistance:

Documentation was discussed with the provider.

Comments:

Type of inspection: Monitoring Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 4/23/25 (8:45 AM - 6:45 PM) Number of residents present at the facility at the beginning of the inspection: 69 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: Six Number of interviews conducted with residents: Six Number of interviews conducted with staff: Five Observations by licensing inspector: Meals, medication administration, activities Additional Comments/Discussion: 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 Marshall Massenberg, Licensing Inspector at (804) 543-5188 or by email at Marshall.x.massenberg@dss.virginia.gov.

Violations:

Standard #:	22VAC40-73-450-E
Description:	Based on record review, the facility did not ensure that the individualized service plan (ISP) is signed by the administrator (or their designee), and by the resident or their legal representative. Evidence: Resident #1's record was reviewed during the inspection. Resident #1's record contained an ISP that was completed within the past year, but the last ISP that was signed by the resident (or his legal representative) was dated 6/10/23. Resident #2's record was reviewed during the inspection. Resident #2's record contained an ISP that was completed within the past year, but no ISP was observed in the resident record that was signed by the resident or her legal representative. Resident #4's record was reviewed during the inspection. Resident #4's record contained an ISP that was completed within the past year, but the last ISP that was signed by the resident (or her legal representative) was dated 12/18/23.
Plan of Correction:	ED/RCD/ALC/RC will ensure there is email documentation for any ISP where family/POA is unable to be onsite to sign. Also, the team will review monthly for compliance.
Standard #:	22VAC40-73-460-D
Description:	Based on record review, the facility did not provide supervision of resident schedules, care, and activities including attention to specialized needs, such as wandering from the premises. Evidence: Resident #1's record included a progress note, dated 2/3/25, that stated that the resident eloped from the facility's special care unit and exited to the building?s garage without staff supervision.
Plan of Correction:	Immediate and routine elopement drills. All staff in-service to review policy and procedures relating to specialized needs such as wandering and safety for those in the secured memory care neighborhood along with timely responses to any and all alerts.
Standard #:	22VAC40-73-640-A
Description:	Based on documentation and interview, the facility did not ensure that the medication management plan was implemented to ensure that each resident?s prescription medications are filled and refilled in a timely manner to avoid missed dosages. Evidence: Resident #8's April Medication Administration Record (MAR) was reviewed during the inspection. Resident #8's MAR included documentation that he did not receive his Hydrocortisone tablets (ordered 3/21/25) during the morning medication administration on 4/23/25. The MAR documented that the medication was "pending delivery." Facility staff confirmed that the medication was not present in the medication cart at the time of the inspection.
Plan of Correction:	Staff refresher training on timely refill requests. Any delay greater than 24 hours is to be escalated to the wellness nurse/RCD for follow up.
Standard #:	22VAC40-73-660-B
Description:	Based on observation and documentation, the facility did not ensure that medication storage is limited to an out-of-sight place in the rooms of those residents whose UAI has indicated that the resident is capable of self-administering medication. Evidence: At approximately 9:35 AM Tylenol tablets and two capsules with a "TEVA 0812 50mg" imprint were observed in a room on the facility?s safe, secure neighborhood. The room was vacant, but it had previously been occupied by Residents #1 and #7. Resident #1's UAI, dated 4/24/24, states that the resident needs staff assistance for medication administration. Resident #7's UAI, dated 5/28/24, states that the resident needs staff assistance for medication administration.
Plan of Correction:	Apartment inspections to be completed upon move out to ensure nothing is left behind and apartment will be secured. The walk through will be conducted with family/POA and Sunrise representative.
Standard #:	22VAC40-73-680-M
Description:	Based on observation and interview, the facility did not ensure that medications ordered for PRN administration are available and properly stored at the facility. Evidence: Resident #3's PRN Imodium and PRN Meclizine were not available for administration, at the time of the medication cart inspection. Resident #3 did have a package of Meclizine tablets, but it had expired on 1/31/25. Facility staff confirmed that Resident #3's PRN Imodium and PRN Meclizine were not available for administration, at the time of the medication cart inspection. Resident #5's PRN Albuterol and PRN Benzonatate were not present, at the time of the medication cart inspection. Facility staff confirmed that Resident #5's PRN Albuterol and PRN Benzonatate were not present, at the time of the medication cart inspection. Resident #6's PRN Guaifenesin and PRN Loperamide were not present, at the time of the medication cart inspection. Facility staff confirmed that Resident #6's PRN Guaifenesin and PRN Loperamide were not present, at the time of the medication cart inspection.
Plan of Correction:	Med cart audits were completed with focus on PRN medications. Expiration dates checked and refills ordered. Also, followed up on medications that needed to be discontinued by providers. Inservice was scheduled for medication techs and nurses on PRN medication procedures. Continued monthly medication cart audits to be performed.