VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Avalon House on Dominion Crest Lane
1804 Dominion Crest Lane
Mc lean, VA 22101
(301) 656-8823

Current Inspector: Jacquelyn Kabiri (703) 397-3017

Inspection Date: May 8, 2025

Complaint Related: No

Areas Reviewed:

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 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

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: 05/09/2025, 8:20 a.m. to 12:00 p.m. 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: 1 Observations by licensing inspector: Breakfast and exercise Additional Comments/Discussion: none 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 Jacquelyn Kabiri, Licensing Inspector at (703) 397-3017 or by email at Jacquelyn.Kabiri@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-530-B
Description:	Based on observation and interview, the facility failed to ensure doors leading to the outside not be locked from the inside or secured from the inside in any manner that amounts to a lock. Evidence: 1. On 05/09/2025, LI observed the front door was equipped with multiple locking mechanisms, including: a. One lock that secures into the top of the door frame. b. One lock that secures into the floor. c. One thumbturn lock. 2. During the inspection, the kitchen (emergency exit) door also had a thumbturn deadbolt and a lock on the doorknob. 3. Staff 1 confirmed the thumbturn deadbolt on the kitchen door was not locked during the inspection. 4. Photo evidence taken.
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 has been retrained about the locks on all outgoing doors on 5/10/25 & 5/23/25
Standard #:	22VAC40-73-860-D
Description:	Based on observations, the facility failed to have an operable window effectively screened. Evidence: 1. During the onsite inspection with staff 1, it was observed that windows in residents 1, 2, and 4?s rooms were not screened. 2. Photo evidence taken.
Plan of Correction:	Facility has arranged with a handyman to do the following: a. Fix or replace any torn or missing screens from windows (completed 5/20/25) b. Repair leaking windowsill (completed 5/20/25)
Standard #:	22VAC40-73-860-I
Description:	Based on observations, the facility failed to ensure that cleaning supplies and other hazardous materials were stored in a locked area. Evidence: 1. The third level bathroom shower had two disposable razors in the shower caddy. The vanity cabinets had one pink disposable razor, and one clear plastic bowl, containing power laundry detergent. 2. The bathroom countertop had a basket containing face and hair products and two, 16 oz bottles of mouthwash. 3. Photo evidence taken.
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-E
Description:	Based on observations, the facility failed to keep all furnishings, fixtures, and equipment clean and in good repair and condition. Evidence: 1. Resident 2?s bedroom window screen is torn. 2. Resident 3?s bedroom window had paper towels pushed against the windowsill, to keep the water out. 3. Resident 4?s window had broken blinds. 4. The living room wall had two areas where the drywall was chipped and scrapped behind the recliner chairs. 5. Photo evidence taken.
Plan of Correction:	Facility has arranged with a handyman to do the following: a. Fix or replace any torn or missing screens from windows (completed 5/20/25) b. Repair leaking windowsill (completed 5/20/25) c. Replace broken blinds d. Repair chipped/scraped drywall in living room Facility Manager & administrator will do spot checks and report any item needing to be repaired to the management team.