VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Avalon House in McLean
1503 Oakview Drive
Mclean, VA 22101
(301) 656-8823

Current Inspector: Amanda Velasco (703) 397-4587

Inspection Date: May 19, 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 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS 22VAC40-90 THE SWORN STATEMENT OR AFFIRMATION 22VAC40-90 THE CRIMINAL HISTORY RECORD REPORT

Technical Assistance:

Written Schedule Upcoming renewal reminder

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: 05/19/2025 9:00 AM to 1:55 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: 7 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 2 Number of staff records reviewed: 3 Number of interviews conducted with residents: 1 Number of interviews conducted with staff: 4 Observations by licensing inspector: Meals, Activities, Medication Pass, 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 #:	22VAC40-73-100-A
Description:	Based on facility document review and staff interview, the facility failed to ensure that the infection control program was consistent with the Center for Disease Control (CDC) and Occupational Safety and Health Administration (OSHA) guidelines. Evidence: 1. On 05/19/2025, Staff 2 provided a copy of the infection control program. The infection control program was dated as implemented/revised on 02/2007. 2. The CDC?s ?Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings? was updated in both July of 2014 and November of 2022 per CDC.GOV. 3. The OSHA Infectious Diseases efforts were last updated and released in Spring of 2017 per OSHA.GOV. 4. In a phone interview with the LI on 05/19/2025, Staff 1 acknowledged that the infection control program is not consistent with the most recent guidance from CDC and OSHA.
Plan of Correction:	RN will update the facility infection control program so that it is consistent with the CDC and OSHA Guidelines.
Standard #:	22VAC40-73-100-C-1
Description:	Based on direct observation and staff interview, the facility failed to ensure the implementation of procedures of infection prevention measures by staff to include hand hygiene. Evidence: 1. On 05/19/2025, two licensing staff observed Staff 5 administer medication to Resident 1. The staff member was not observed washing their hands prior to, during, or after administering medications. 2. Staff 2 provided the infection control program dated 02/2007 which states ?Handwashing is to occur?during medication administration?? under the ?Procedures? for ?Staff.? 3. In a phone interview with the LI on 05/19/2025, the Staff 1 acknowledged that Staff 5 did not wash their hands prior to, during, or after administering medication.
Plan of Correction:	While the Medication Technician did wear nitrile gloves during the medication pass observed, they did not wash their hands prior to putting their gloves on. Staff have been retrained to wash hands prior to placing gloves on to administer medications.
Standard #:	22VAC40-73-50-A
Description:	Based on resident record review and staff interview, the facility failed to ensure that the disclosure statement was on a form developed by the department. Evidence: 1. Resident 3?s, admitted 05/01/2025, record contained a disclosure statement prepared on the form version number 032-05-0849-06-eng (10/19). 2. In a phone interview with the LI on 05/19/2025, Staff 1 confirmed that the form was not on the most recent version of the department developed form.
Plan of Correction:	The management team will update the disclosure form & ensure it is the most recent version. Administrator will ensure it is sent/given to any incoming resident with the admission document packet.
Standard #:	22VAC40-73-190-D
Description:	Based on direct observation, facility document review, and staff interview, the facility failed to ensure the designated direct care staff person in charge was on the premises while in charge. Evidence: 1. On 05/19/2025, the LI observed the person-in-charge posted as Staff 4. 2. In an interview with the LI, Staff 5 stated that Staff 4 was out at an appointment. 3. In a phone interview with the LI on 05/19/2025, Staff 1 acknowledged that Staff 4 was not on the premises while in charge. 4. Photo evidence obtained.
Plan of Correction:	Staff have been retrained to ensure the posted the person in charge sign is accurate & change as needed. Manager and administrator will do spot checks to ensure the appropriate person in charge sign is hanging up.
Standard #:	22VAC40-73-280-B
Description:	Based on staff interview, the facility failed to ensure that a written staffing plan that specifies the number and type of direct care staff required to meet the day to day, routine direct care needs and any identified special needs for the residents in care was maintained. Evidence: 1. On 05/19/2025, the LI requested a copy of the written staffing plan. Staff 2 stated that they had to call Staff 1. In a phone interview with the LI on 05/19/2025, Staff 1 confirmed that the facility did not maintain a written staffing plan.
Plan of Correction:	The management team will create a staffing plan & ensure it is available at the facility.
Standard #:	22VAC40-73-640-D
Description:	Based on direct observation and staff interview, the facility failed to ensure that a copy of a pharmacy reference book, drug guide, or medication handbook for nurses that is no more than two years old was readily accessible. Evidence: 1. On 05/19/2025, Staff 2 provided a copy of the facility?s drug guide. The guide was dated 2018/2019. 2. In a phone interview with the LI on 05/19/2025, Staff 1 acknowledged that the drug guide that was readily accessible was more than two years old.
Plan of Correction:	Administrator purchased a new drug guide that is less than two years old. Administrator will do spot checks to ensure it is at the facility.
Standard #:	22VAC40-73-860-I
Description:	Based on direct observation and staff interview, the facility failed to ensure that all cleaning supplies were stored in a locked area. Evidence: 1. On 05/19/2025, two licensing staff observed an unlocked laundry room on the basement level. Within the laundry room, there was an unlocked closet which contained two bottles of Fabuloso, 1 bottle of bleach, 1 container of powder Laundry Detergent, three cans of Febreeze, and two cans of Lysol. 2. In a phone interview with the LI on 05/19/2025, Staff 1 confirmed that the cleaning supplies were not stored in a locked area. 3. Photo evidence obtained.
Plan of Correction:	Staff have been retrained to ensure all cleaning supplies are kept in a locked area. Manager and administrator will do spot checks to ensure they are locked up.
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 were maintained in good repair and kept clean and free of rubbish. Evidence: 1. On 05/19/2025, two licensing staff observed the following during a tour of the building: a. The window lock in the dining area was detached and hanging from the windowsill. b. The signaling device disconnected from the wall and laying on the window ledge of a resident?s room above the bed. c. A whole in the wall with various scuff marks. d. Brown staining and/or ripped areas of carpet were observed on near the baseboards. e. A corner of the bathroom that contained debris including various black particles. f. The corner near the front door had dust and one dead bug. g. The lock on the basement gate had areas of a hole or exposed drywall surrounding the lock. 2. In a phone interview with the LI on 05/19/2025, Staff 1 acknowledged the areas listed above as not being maintained in good repair or kept clean. 3. Photo evidence obtained.
Plan of Correction:	Facility has arranged with a handyman to do the following: a. Attach window lock & ensure it is not hanging in the windowsill b. Place signaling device in resident?s bedroom in an area they may easily reach c. Repair hole in wall and clean up scuff marks d. Repair or replace any ripped or stained areas in carpet in which the stains do not come clean after steam cleaning near the baseboards e. Black particles in the corner of the bathroom has been cleaned on May 20, 2025 f. The dust and one dead bug in the corner near the front door has been cleaned on May 20, 2025 g. The lock on the basement gate that had areas of a hole or exposed drywall surrounding the lock shall be repaired or replaced. Facility Manager & administrator will do spot checks and report any item needing to be repaired to the management team.
Standard #:	22VAC40-73-900
Description:	Based on direct observation and staff interview, the facility failed to ensure that all beds were placed only in bedrooms and that that staff did not share bedrooms with residents. Evidence: 1. On 05/19/2025, two licensing staff observed a bed in the family room on the basement level. 2. In an interview with the LI on 05/19/2025, Staff 5 stated that the bed in the family area was used for respite. 3. In a phone interview with the LI on 05/19/2025, Staff 1 acknowledged that there was a bed in a common area of the facility. 4. On 05/19/2025, two licensing staff observed an unlocked bedroom at the facility. 5. In an interview with the LI on 05/19/2025, Staff 5 stated that a staff member was using the room while Resident 4 was out of the facility. Staff 5 stated Staff 3 was staying in the room. 6. In an interview with the LI on 05/19/2025, Staff 3 stated that they were not sleeping in Resident 4?s room; however, they were keeping their items in Resident 4?s closet during their shift. 7. In a phone interview with the LI on 05/19/2025, Staff 1 acknowledged that Resident 4?s bedroom was being utilized by Staff 3.
Plan of Correction:	The bed in the common area downstairs that was used occasionally by the staff has been removed. Beds will be kept in bedrooms only. Manager & administrator will do spot checks to ensure beds are not kept for use in a common area. Resident 4 was in rehab. Staff did place their belongings in the room since the resident was out of the facility. Staff have been trained that their belongings should be kept in the staff are only. Manager and administrator will do spot checks to ensure staff items are not in resident bedrooms.