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: Sept. 22, 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:

Infection Control Program ? Administrator Signature 610-B, Menus should be posted and dated

Comments:

Type of inspection: Monitoring Date of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 09/22/2025 10:00 AM to 1:08 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: 2 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, Medication Pass. Additional Comments/Discussion: No activities were observed because none were completed during the inspection. 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 #:	22VAC40-73-170-A
Description:	Based on staff record review and staff interview, the facility failed to ensure that each manager had qualifications including having a high school diploma, having post-secondary education, and having one year of administrative or supervisory experience for each facility with a shared administrator. Evidence: 1. During a tour of the facility, the posted manager on duty was Staff 6. In an interview with the LI, Staff 4 stated that Staff 3 was the manager, and Staff 2 was the person in charge prior to the arrival of Staff 3 to the facility. Staff 3 and Staff 4 stated that Staff 6 was no longer employed but could not provide the last date of employment. Staff 2?s qualifications were requested to serve as person in charge, but were not provided. 2. In an email follow-up with Staff 7, Staff 7 stated that Staff 2 was the manager of the facility and provided a certificate for the online learning course hosted by Collateral Contact 1. Staff 7 did not provide documentation that Staff 2 was qualified to act as manager of a facility with a shared administrator.
Plan of Correction:	During the inspection there was a manager at the home upon arrival, another manager, as well as an administrator did arrive at the home during the inspection. Appropriate training certificates will be placed in staff records at the facility & manager will have appropriate qualifications to be a manager.
Standard #:	22VAC40-73-190-A
Description:	Based on direct observation and staff interview, the facility failed to ensure that the designated person in charge was on the premises. Evidence: 1. During a tour of the facility, two LI?s observed the posted person in charge as Staff 6, with Staff 4?s schedule posted above listing the time on site for Monday?s as 8:00 AM to 12:00 PM. 2. In an interview with the LI on 09/22/2025, Staff 2 stated that Staff 6 was no longer employed, and they had contacted Staff 4 by phone to notify them the LI?s were conducting an inspection. Staff 2 confirmed that neither Staff 4 nor Staff 6 were on site. 3. Photo evidence obtained.
Plan of Correction:	One of the facility managers took down the posting for the manager that no longer works for our company and replaced the posting with the current designated person in charge. During the inspection there was a manager at the home upon arrival, another manager, as well as an administrator did arrive at the home during the inspection. Administrator will do spot checks to ensure the appropriate designated person in charge is indicated and hanging up on the bulletin board. Staff at the home were also made aware.
Standard #:	22VAC40-73-190-C
Description:	Based on staff record review and staff interview, the facility failed to ensure that the designated person in charge was informed of their duties and responsibilities and documentation of such was recorded in the staff?s record. Evidence: 1. During a tour of the facility, the posted manager on duty was Staff 6. In an interview with two LI?s on 09/22/2025, Staff 1 stated that Staff 2 was the person in charge. 2. In a review of Staff 2?s records, there was no documentation for Staff 2 being informed of the responsibilities and job duties when in the role of designated person in charge. 3. In an interview with the LI on 09/22/2025, Staff 3 confirmed that Staff 2 was the person in charge and stated that they were unable to provide the designated person in charge training.
Plan of Correction:	During the inspection there was a manager at the home upon arrival. A job duties form was in their chart at the inspection as well as was provided to the inspector via email several days after the inspection. It was signed and dated by the staff 6/8/20. Going forward Administrator will review the responsibilities of the manager with them.
Standard #:	22VAC40-73-290-A
Description:	Based on direct observation and staff interview, the facility failed to ensure that the written schedule included the names and job classifications of all staff working each shift with an indication of who?s in charge at any given time. Evidence: 1. During a tour of the facility, two LI?s observed the posted staff schedule for September 16th 2025 through September 30th, 2025 which did not include an indication of who?s in charge at any given time and multiple dates had blanks or quotation marks? next to the date. 2. In an interview with two LI?s on 09/22/2025, Staff 3 confirmed the schedule did not list the names for each staff working each shift or an indication of who?s in charge at any given time. 3. Photo evidence obtained.
Plan of Correction:	The staff schedule that was posted on the board did include the staff names that were working at the home at that time. However, it did not include the staff names that have worked at that home in the past few months but were not currently at that home working written on it. It did not indicate who was in charge at that time. The ?quotation marks? were not quotation marks. They were ditto marks indicating it was the same staff person or staff people who were working the following day. The staff schedule will be updated to include any staff who have recently worked in the home even when not at the home, as well as indicate the designated person in charge. The administrator will do spot checks to ensure the schedule is completed.
Standard #:	22VAC40-73-390-C
Description:	Based on observation, resident record review, and staff interview, the facility failed to ensure that the agreement or acknowledgement was updated when there are changes to the information referenced or identified in the agreement. Evidence: 1. During a tour of the facility on 09/22/2025, two LI?s came across an unlabeled, unlocked resident room. Inside of the room, Staff 5 (identified later by Staff 2) was observed asleep. 2. In an interview with the LI on 09/22/2025, Staff 2 and Staff 4 stated that Staff 5 was asleep in Room 4, but Room 4 was reserved for Resident 4. Staff 2 and 4 stated that Resident 4 now resides with Resident 5 and no longer needs Room 4. 3. Upon resident record review, Resident 4 and Resident 5 have separate agreements. Both agreements are dated 09/03/2024, and state that a furnished bedroom will be provided to both Resident 4 and Resident 5. Neither agreement reflects the change to one shared bedroom.
Plan of Correction:	Resident 4 and Resident 5 are married. While originally they rented two different rooms, both expressed they prefer to sleep in the same room. Since that is their resident right, both had agreed as well their responsible party, facility had allowed them to share the larger of the two rooms. That being the case, the facility staff did use the smaller of the two rooms. Management team has discontinued using the unused resident room (Resident 4) for the caregivers. Should another married couple move into this home, facility will ensure if they are sharing a room their resident agreements will each indicate that.
Standard #:	22VAC40-73-390-C
Description:	Based on observation, resident record review, and staff interview, the facility failed to ensure that the agreement or acknowledgement was updated when there are changes to the information referenced or identified in the agreement. Evidence: 1. During a tour of the facility on 09/22/2025, two LI?s came across an unlabeled, unlocked resident room. Inside of the room, Staff 5 (identified later by Staff 2) was observed asleep. 2. In an interview with the LI on 09/22/2025, Staff 2 and Staff 4 stated that Staff 5 was asleep in Room 4, but Room 4 was reserved for Resident 4. Staff 2 and 4 stated that Resident 4 now resides with Resident 5 and no longer needs Room 4. 3. Upon resident record review, Resident 4 and Resident 5 have separate agreements. Both agreements are dated 09/03/2024, and state that a furnished bedroom will be provided to both Resident 4 and Resident 5. Neither agreement reflects the change to one shared bedroom.
Plan of Correction:	Management team has discontinued using the unused resident room (Resident 4) for the caregivers. From now on Resident 4 & 5 will have their own bedrooms.
Standard #:	22VAC40-73-520-E
Description:	Based on direct observation and staff interview, the facility failed to ensure that there was at least 14 hours of scheduled activities available to residents each week for no less than one hour each day. Evidence: 1. During the inspection, two LI?s did not observe any activities conducted between staff and the residents. 2. In an interview with two LI?s on 09/22/2025, Staff 3 confirmed that no activities were completed during the inspection.
Plan of Correction:	Facility staff did offer activities to the residents during the inspection. At that time, residents verbalized they did not want to do any at that time. Since it is their resident rights to turn down doing activities, the facility staff honored the facility resident wishes. Facility staff did mention the residents did say no to the inspectors. Facility will continue to offer a minimum of 14 hours of activities per week to the residents as well as honor the resident rights if they verbalize they do not want to participate. Administrator will offer activities during their visits as well as do spot checks they are being offered.
Standard #:	22VAC40-73-530-B
Description:	Based on direct observation and staff interview, the facility failed to ensure that doors leading to the outside were unlocked. Evidence: 1. During a tour of the facility on 09/22/2025, two LI?s observed both the front and back doors that lead to the outside being locked. The back door remained locked for the duration of the inspection (approximately three hours). 2. In an interview with two LI?s, Staff 3 acknowledged that both doors were locked. 3. Photo evidence obtained.
Plan of Correction:	Facility staff had been trained 4/23/25 about the doors leading to the outside should only have a one turn lock. Staff will be retrained. Administrator will do spot checks. Management will hire a handy man to change locks on outgoing doors ensuring they are one turn locks on the doors
Standard #:	22VAC40-73-700-2
Description:	Based on direct observation, resident record review, and staff interview, the facility failed to ensure that ?No smoking ? Oxygen in use? signs were posted when oxygen therapy is provided to residents. Evidence: 1. During a tour of the facility, two LI?s observed oxygen concentrators in the room of Resident 1 and Resident 2, but both rooms did not have signs posted on the door. 2. The records of both Resident 1 and Resident 2 contained signed, active orders for oxygen therapy. 3. In an interview with two LI?s on 09/22/2025, Staff 3 confirmed that Resident 1 and Resident 2?s rooms did not contain ?No smoking ? Oxygen in use? signs. 4. Photo evidence obtained.
Plan of Correction:	The facility does have and always had a no smoking policy and does not allow for any smoking in the facility. No smoking signs will be obtained and hung up on the doors of the rooms I which residents are using oxygen. Administrator will do spot checks.
Standard #:	22VAC40-73-720-A
Description:	Based on resident record review and staff interview, the facility failed to ensure that Do Not Resuscitate (DNR) orders were valid. Evidence: 1. Resident 1?s record contains a DNR signed 10/15/2024 that was not completed does not have all the required boxes checked. 2. Resident 2?s record contains a DNR signed 09/12/2023 was not completed and that does not have all the required boxes checked. 3. In an interview with two LI?s on 09/22/2025, Staff 3 confirmed that the DNR orders were not valid due to being incomplete.
Plan of Correction:	The DNR in the chart provided by the responsible party was sent into the doctor to check off the appropriate boxes to ensure the DNR is valid. Facility is waiting for it to be returned. Once returned it will be placed in the resident?s chart. RN and administrator will review DNRs provided by resident responsible parties, or their primary care team to ensure all appropriate boxes are checked off. If they are not, they will be returned to be filled out appropriately.
Standard #:	22VAC40-73-860-I
Description:	Based on direct observation and staff interview, the facility failed to ensure that cleaning supplies were stored in a locked area. Evidence: 1. During a tour of the facility, two LI?s observed six (6) bottles of cleaning supplies in an unlocked bathroom cabinet on the first floor across from Resident 1?s room. The cleaning products included two bottles of Febreze, a bottle of bleach, a bottle of Clorox spray, a bottle of pine-sol, and an aerosol spray. 2. In an interview with two LI?s on 09/22/2025, Staff 3 acknowledged that cleaning supplies were not stored in a locked area and confirmed that this was a bathroom used by residents. 3. Photo evidence obtained.
Plan of Correction:	The facility staff has been trained by the administrator as well as RN about keeping cleaning products kept locked up 4/17/25. They will be retrained by the RN. Administrator will do spot checks.
Standard #:	22VAC40-73-870-A
Description:	Based on direct observation and staff interview, the facility failed to ensure that the interior of the building was kept in good repair and clean. Evidence: 1. During a tour of the facility, two LI?s observed the following items in disrepair: a. Cracked door frame on the closet in the hallway outside of room 1 b. Hole in the door of the bathroom across from room 1 c. Light bulb frame falling out of the ceiling in the bathroom across from room 1 d. Hole in the carpet in room of Resident 1 e. Brown stain on the wall near the towel holder in the bathroom across from room 2 f. Wall patching covering the lower half of the wall in the bathroom of room 7 g. A missing faucet from the tub resulting in the pipe sticking out of the wall in the bathroom of room 7 h. The arms of a dining chair unscrewed and hanging at the side of the chair 2. In an interview with two LI?s on 09/22/2025, Staff 3 and 4 acknowledged the photo evidence and confirmed the interior was not kept in good repair. 3. Photo evidence obtained.
Plan of Correction:	Facility has hired a handy man to repair the following items: 1. Cracked door frame on hallway closet outside of room 1 2. Hole in the door of the bathroom across from room 1 3. Light bulb frame falling out of the ceiling in the bathroom across from room 1 4. Hole in the carpet of room 1 5. Wall patching covering the lower half of the wall om the bathroom of room 7 6. Missing faucet from the tub in the bathroom of room 7 7. Arms of the dining room chair Facility has cleaned the stain on the wall near the towel holder of the bathroom located near room 2.
Standard #:	22VAC40-73-900
Description:	Based on direct observation, resident record review, and staff interview, the facility failed to ensure that there were no less than 80 square feet per person in bedrooms accommodating two or more residents. Evidence: 1. During a tour of the facility on 09/22/2025, two LI?s came across an unlabeled, unlocked resident room. Inside of the room, Staff 5 (identified later by Staff 2) was asleep. 2. In an interview with the LI on 09/22/2025, Staff 2 and Staff 4 stated that Staff 5 was asleep in Room 4, but room 4 was reserved for Resident 4 and Resident 5, a married couple that chooses to sleep together in one room, Room 3. 3. Room 3 has 156 square footage, per the calculations completed for the facility?s initial inspection on 04/01/2008 with a noted maximum capacity of 1 resident. 4. In an interview with the LI on 09/22/2025, Staff 3 confirmed both Resident 4 and Resident 5 reside in Room 3.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-925-A
Description:	Based on direct observation and staff interview, the facility failed to ensure that toilet tissue was accessible to each commode. Evidence: 1. During a tour of the facility, two LI?s observed no toilet tissue in the first-floor bathroom across from Room 2. The toilet tissue was not replaced during the duration of the inspection (approximately three hours). 2. In an interview with two LI?s on 09/22/2025, Staff 3 acknowledged that there was no toilet paper in the bathroom on the first floor. 3. Photo evidence obtained.
Plan of Correction:	Toilet tissue has been placed in all bathrooms. Staff will be retrained to keep toilet tissue in the bathrooms. Administrator will do spot checks.
Standard #:	22VAC40-73-925-B
Description:	Based on direct observation and staff interview, the facility failed to ensure that hand-washing sinks had paper towels or an air dryer. Evidence: 1. During a tour of the facility, two LI?s observed no paper towels or air dryers in the first-floor bathroom across from Room 2. The paper towels were not replaced during the duration of the inspection (approximately three hours). 2. In an interview with two LI?s on 09/22/2025, Staff 3 acknowledged that there were no paper towels in the first-floor bathroom. 3. Photo evidence obtained.
Plan of Correction:	Paper towels have been placed in all bathrooms. Staff will be retrained to keep paper towels in the bathrooms. Administrator will do spot checks.