VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Avalon House on Laburnum Street
1453 Laburnum Street
Mc lean, VA 22101
(301) 656-8823

Current Inspector: Jacquelyn Kabiri (703) 397-3017

Inspection Date: Sept. 29, 2025

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-80 Complaint Investigation

Technical Assistance:

Keep bathrooms supplied with paper towels or other means to dry hands.

Comments:

Type of inspection: ?Complaint? Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 09/29/2025, 12:40 p.m. to 1:40 p.m. The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. A complaint was received by VDSS Division of Licensing on (08/26/2025) regarding allegations in the area(s) of: Resident Care and Related Services. 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: 1 Number of staff records reviewed: 1 Number of interviews conducted with residents: 0 Number of interviews conducted with staff: 1 Observations by licensing inspector: Activities and lunch Additional Comments/Discussion: none. An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation did not support the allegation(s) of non compliance with standard(s) or law. However, violation(s) not related to the complaint(s) but identified during the course of the investigation can 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 Jacquelyn Kabiri, Licensing Inspector at (703) 397-3017or by email at Jacquelyn.Kabiri@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-660-A
Complaint related:	No
Description:	Based on direct observation and staff interview, the facility failed to ensure that a medicine cabinet, container, or compartment shall be used for storage of medications, medication supplies, or dietary supplements. The storage area shall be locked. Evidence: 1. On 09/29/2025, at approximately 12:43 P.M., the Licensing Inspector (LI) observed a box labeled with resident 2?s name lying on the kitchen table. The box contained an Ascensia diabetic glucose monitoring machine. 2. Staff 1 acknowledged the box containing the medical device and promptly stored it in a locked cabinet. 3. Photo evidence taken.
Plan of Correction:	Medication Technicians will be retrained about the proper storage of medication supplies. RN will do spot checks to ensure medication supplies are kept locked up per licensing regulations.