The Landing Alexandria

Based on resident review, the facility failed to ensure Do Not Resuscitate (DNR) Orders are included in the resident?s individualized service plan. Evidence: Resident 3?s DNR Order (03/19/2025) was not included in their ISP

Based on record review and staff interview, the facility failed to ensure that all residents were included at least annually in health care oversight. Evidence: 1. During the onsite inspection, the facility provided two health care oversights completed 07/19/2024 ? 12/10/2024 included twelve residents and 12/10/2024 ? 06/10/2025 which reviewed a total of twelve residents. 2. Staff 5 confirmed over the past 12 months all residents were not included at least annually in health care oversight as only 12 residents are reviewed every six months with the census of 113.

Based on resident review and staff interview, the facility failed to ensure that a medicine compartment was used for storage of medications for residents when administered by the facility. Medications were stored in a manner consistent with current standards of practice. Evidence: 1. During a medication review on 07/15/2025, a bottle of Acetaminophen was noted to be unlocked and stored in resident 4?s bedroom within the safe, secure unit. 2. Staff 6 confirmed resident 4 is administered Acetaminophen 325 MG by the facility, and it was insecurely stored in resident 4?sroom instead of in a locked storage area.

Based on resident review, the facility failed to ensure the comprehensive individualized service plan ( ISP

Based on resident review, the facility failed to ensure that medications, diet, and treatments were not started, changed, or discontinued without an order from a physician or other prescriber. Evidence: 1. Resident 1?s February 2025 physician?s order did not include a diabetic pump, insulin, or diabetic diet.

Based on staff record review and staff interview, the facility failed to ensure that each direct staff member maintained current certification in first aid from the American Red Cross, American Heart Association, National Safety Council, American Safety and Health Institute, community college, hospital, volunteer rescue squad, or fire department. The certification must either be in adult first aid or include adult first aid. Evidence: 1. Staff 2 received first aid certification on 04/01/2022 through National CPR Foundation. 2. Staff 3 received first aid certification on 09/18/2022 through American Health Care Academy. 3. Staff 4 received first aid certification on 08/11/2024 through National CPR Foundation. 4. Staff 4?s (hire date, 05/09/2024) record did not contain first aid certification. 5. On 08/26/2024, LI interviewed Staff 11 who stated Staff 4 renewed first aid certification on 08/11/2024, 3 months after hire date.

Based on resident record review, the facility failed to ensure that prior to admitting a resident with a serious cognitive impairment, the licensee, administrator, or designee determined whether placement in the special care unit was appropriate. Evidence: Resident 2?s (admit date, 03/06/2023) record did not contain a determination and justification for the decision of placement in a safe, secure environment.

Based on resident record review and staff interview, the facility failed to ensure that a physician?s or other prescriber?s oral order was reviewed and signed by a physician or other prescriber within 14 days. Evidence: 1. Resident 4 received an oral physician?s order for a grab bar that stated, ?grab bar on Rt and Standing Pole on left side to promote independency with transfers and bed mobility? on 05/20/2024 but was not signed by the physician or other prescriber within 14 days. 2. Resident 4?s oral physician order was reviewed on 07/01/2024 via a phone call. On 07/31/2024, LI interviewed Staff 11 who stated that the order was reviewed with the physician on the phone, 07/30/2024.

Based on resident?s record review, the facility failed to ensure that six months after placement of the resident in the safe, secure environment and annually thereafter, the licensee, administrator, or designee performed a review of the appropriateness of each resident?s continued residence in the special care unit. Evidence: Resident 1?s (admit date, 07/11/2023) Resident 2?s (admit date, 03/06/2023), and Resident 6?s (admit date, 09/06/2023) records did not contain a six-month review for continued appropriateness.

Based on resident record review and staff interview, the facility failed to ensure that no medication, dietary supplement, diet, medical procedure, or treatment was started, changed, or discontinued by the facility without a valid order from a physician or other prescriber. Medications include prescription, over the counter, and sample medications. Evidence: 1. On 07/21/2024, Resident 5 (admit date, 06/25/2024) was admitted to the hospital following a fall with injury. On 07/23/2024, Resident 5 was discharged from the hospital. Resident 5?s daughter transported her from the hospital back to the facility. Resident 5?s daughter advised staff to withhold Resident 5?s evening medications because they had been administered by the hospital staff. 2. On 07/23/2024, staff documented in Resident 5?s progress notes, ?daughter requested medication not be given this evening. Per daughter ?she already took medication in the hospital before transfer to the facility this evening.? 3. There was not a physician?s or other prescriber?s order to withhold evening medications on 07/23/2024. 4. On 08/26/2024, LI interviewed Staff 11 who stated another employee was present at the time that Resident 5 returned to the facility. Staff 11 did not provide a physician?s or other prescriber?s order to withhold evening medications. 5. Resident 8?s (admit date, 07/12/2024) order for Carbidopa-Levodopa 25 mg ? 100 mg (take 1 tab by mouth three times daily) was ordered on 07/26/2024, delivered on 07/26/2024, administered on 07/26/2024, but missed doses on 07/29/2024, 07/30/2024, and 07/31/2024. 6. Resident 9?s (admit date, 05/11/2023) Prevident 5000 Sensitive 12?s, Mild Mint 1.1%-5% Paste (apply after brushing, flossing, and rinsing ? do not eat, drink or rinse for 30 minutes) was ordered on 11/27/2023, initially administered on 11/28/2023, but was not recorded on any MAR

Based on resident record review, the facility failed to ensure that the fall risk rating was reviewed and updated after a fall. Evidence: 1. Resident 4?s (admit date, 05/11/2023) progress notes state that he had a fall on 07/08/2024, 07/09/2024, 07/11/2024, 07/15/2024, 07/28/2024, 07/30/2024, and 07/31/2024. 2. A post fall risk rating was not completed for Resident 4 (admit date, 05/11/2023) on 07/15/2024, 07/30/2024, and 07/31/2024.

Based on LI observations, the facility failed to ensure that all staff were trained in the relevant laws, regulations, and the facility?s policies and procedures sufficiently to implement confidential treatment of personal information. Evidence: 1. Resident 4?s (admit date, 05/11/2023) proposed schedule/goals was taped on the wall in the unlocked third floor nurse?s station. The nurse?s station is setup as a captured room with resident apartments across the hall and to the left of the room. The first door is unlocked and contains a desk on the right-hand side, with one chair by the door, and two chairs lined on the left side of the room. The second room is straight ahead, locked, and contains the medication cart. 2. Resident 8?s physician oral order (date, 07/26/2024) was sitting upright, name at the top in a tray. The tray was located on the left-hand side of the desk, against the wall, and furthest from the unlocked the door. 3. Resident 11?s resident onboarding process checklist was on the desk of the conference room. The conference room is located in the open administrative suite, with floor to ceiling glass windows, where residents and guests frequent. 4. Photo evidence was taken.

Based on resident record review, the facility failed to ensure that the comprehensive individualized service plan was completed within 30 days after admission and included a written description of what services would be provided to address identified needs, and if applicable, other services and who will provide them; when and where the services will be provided; the expected outcome and time frame for expected outcome, and date outcome achieved. Evidence: 1. Resident 4?s (admit date, 05/11/2023) identified needs per the uniformed assessment instrument ( UAI

Based on resident record review, the facility failed to ensure that prior to placing a resident with a serious cognitive impairment in a safe, secure environment, written approval was obtained by the resident, guardian or other legal representative, a relative who was willing and able to take responsibility to act as the resident?s representative or an independent physician. Evidence: Resident 2?s (admit date, 03/06/2023) record did not contain written approval for admission to a special care unit.

Based on facility record review, the facility failed to ensure a semi-annual review on the emergency preparedness and response plan was completed for all staff and residents, with emphasis placed on an individual?s respective responsibilities. Evidence: Upon request the facility did not provide evidence of the semi-annual review of the emergency preparedness and response plan for any staff and residents.

Based on resident record review and staff interview, the facility failed to implement a written plan for medication management to ensure methods for verifying that medication orders have been accurately transcribed to medication administration records ( MAR

Based on facility record review, the facility failed to ensure that a record of the required fire and emergency evacuation drills were kept in the facility for two years and include the identity of the person conducting the drill, the number of residents participating, any special conditions simulated, the time it took to complete the drill, and weather conditions. Evidence: 1. The January - April 2024 fire and emergency evacuation drills were requested and reviewed. 2. On 02/29/2024, the fire and emergency evacuation drill did not contain the method used for notification of the drill. 3. On 05/26/2024, the fire and emergency evacuation drill did not contain the number of residents participating, any special conditions simulated, the time it took to complete the drill, and weather conditions.

Based on facility record review, the facility failed to ensure that the emergency preparedness and response plan included an emergency generator and a description of the generator?s capacity to provide sufficient power for the operation of lighting, ventilation, temperature control, supplied oxygen, and refrigeration. Evidence: 1. The emergency preparedness and response plan was reviewed by Staff 7 and Staff 12 following the inspection, 07/29/2024. On 07/29/2024, LI reviewed the emergency preparedness and response plan, and the plan did not include the generator?s capacity to provide sufficient power for the operation of lighting, ventilation, temperature control, supplied oxygen, and refrigeration.

Based on resident record review, the facility failed to ensure that within the 30 days preceding admission, a person completed a physical examination by an independent physician. Evidence: 1. Resident 2 (admit date, 03/06/2023) was admitted to Assisted Living on 09/16/2022 and transferred to the special care unit on 03/06/2023. Resident 2 received two separate physical examinations, 04/28/2022 and 06/13/2022, both completed prior to 30 days preceding admission. 2. The physical examination, 06/13/2022 was missing Resident 2?s pulse and blood pressure.

Based on facility record review, the facility failed to ensure that at least once every six months, all staff currently on duty on each shift participated in an exercise in which the procedures for resident emergencies were practiced. Evidence: 1. Resident emergency and practice exercises were completed on 02/29/2024 (3 PM ? 11 PM), 05/08/2024 (7 AM ? 3 PM), 05/10/2024 (3 PM ? 11 PM), and 05/22/2024 (7 AM ? 3 PM) but did not include third shift. 2. On 02/29/2024 a total of 54 employees were on duty at the facility. Five employees signed the in-service training form. 3. On 05/08/2024, a total of 62 employees were on duty at the facility. Nine employees signed the in-service training form. 4. On 05/10/2024, a total of 63 employees were on duty at the facility. Five employees signed the in-service training form. 5. On 05/22/2024, a total of 66 employees were on duty at the facility. Six employees signed the in-service training form.

Based on resident record review, the facility failed to ensure that a risk assessment for tuberculosis was completed annually on each resident as evidenced by the completion of the current screening form published by the Virginia Department of Health or a form consistent with it. Evidence: 1. Resident 1?s (admit date, 07/11/2023) record did not contain an annual risk assessment for tuberculosis. 2. Resident 1?s most recent tuberculosis screening was completed on 06/08/2023.

Based on documentation and interviews, the facility failed to ensure that each resident is free of physical restraint except in the following situations with appropriate safeguards: a. As necessary for the facility to respond to unmanageable behavior in an emergency situation, which threatens the immediate safety of the resident or others; b. As medically necessary, as authorized in writing by a physician, to provide physical support to a weakened resident; Evidence: On 1/19/24, several witnesses reported that Resident #1 entered the kitchen area during the evening meal to sing a song to the staff members. Resident #1 was asked to leave the kitchen area, but she refused and told the staff members not to touch her. Staff #1 reportedly wrapped her arms around Resident #1 and physically removed the resident from the kitchen area. Virginia administrative code (22VAC40-73-10) defines a physical restraint as any manual method or physical or mechanical device, material, or equipment attached or adjacent to the resident?s body that the resident cannot remove easily, which restricts freedom of movement or access to his body. The Centers for Medicare and Medicaid Services defines the "manual method" as a means to hold or limit a resident?s voluntary movement by using body contact as a method of physical restraint. None of the interviews indicated that Resident #1, or any other resident, was in immediate danger by Resident #1's presence in the kitchen area. Staff #1's record was reviewed during the inspection and it indicates that she was hired on 12/19/22 as the Assistant Dining Services Director. No documentation, was included in Staff #1's record, to confirm that she met the qualifications for direct care staff to provide any type of physical assistance to residents, nor did the record contain any training for the implementation of restraints. The record for Resident #1 did not include a physician?s order for the use of physical restraints and her individualized service plan ( ISP

Based on documentation, the facility failed to ensure a prompt response by staff to resident needs as reasonable to the circumstances. Evidence: Call bell reports (for 30 days) were reviewed for Residents #1, #2, and #3. Resident # 1's call bell report indicated that there were 34 occasions when it took staff at least 20 minutes to respond to the resident's call bell (out of 88 call alarms). Resident #2?s call bell report indicated that there were 19 occasions when it took staff at least 20 minutes to respond to the resident?s call bell (out of 42 call alarms). Resident #3?s call bell report indicated that there were two occasions when it took staff at least 20 minutes to respond to the resident?s call bell (out of two call alarms).

Based on documentation, the facility failed to ensure that each staff member attends 18 hours of annual training. EXCEPTION: Direct care staff who are licensed health care professionals or certified nurse aides shall attend at least 12 hours of annual training. Evidence: Staff records were reviewed during the inspection. Staff training data was not provided, during the inspection, for Staff #1 and Staff #2.

Based on documentation, the facility failed to ensure that each staff member annually submits the results of a tuberculosis risk assessment, documenting the absence of tuberculosis in a communicable form as evidenced by the completion of the current screening form published by the Virginia Department of Health or a form consistent with it. Evidence: Records for Staff #2, #3, and #5 did not contain a tuberculosis risk assessment that was completed within the past year.

Based on record review, the facility failed to ensure that direct care staff members maintain current certification in first aid from the American Red Cross, American Heart Association, National Safety Council, American Safety and Health Institute, community college, hospital, volunteer rescue squad, or fire department. Each direct care staff member who does not have current certification in first aid, shall receive certification in first aid within 60 days of employment. Evidence: The record for Staff #2, hired 9/26/22, was reviewed during the inspection. The record for Staff #2 contained a nurse aide certification. No documentation was provided, during the inspection, to indicate that Staff #2 has current certification in first aid.

Based on observation, the facility failed to ensure that if one activity is substituted for another, the change is noted on the schedule. Evidence: The Jokes and Giggles social with snacks was on the schedule for the facility?s memory care unit on 8/8/23 at 3:30 PM. At approximately 3:45 PM, residents were observed sitting and watching television. No snacks were observed while the residents were sitting and watching television.

Based on record review, the facility failed to ensure that each resident is assessed by an independent clinical psychologist licensed to practice in the Commonwealth or by an independent physician as having a serious cognitive impairment due to a primary psychiatric diagnosis of dementia with an inability to recognize danger or protect his own safety and welfare. Evidence: Resident #2?s record was reviewed during the inspection. Resident #2?s assessment of serious cognitive impairment form, dated 1/30/23, states that she can recognize danger and protect her own safety and welfare.

Based on observation and documentation, the facility failed to ensure that medications are administered in accordance with the physician?s or other prescriber?s instructions and consistent with the standards of practice outlined in the current medication aide curriculum approved by the Virginia Board of Nursing. Evidence: Medication administration, for Resident #8, was observed during the inspection. Resident #8?s Donepezil was not given during the observed medication pass on 8/8/23, as it was reportedly unavailable. Resident #8?s MAR

Based on record review, the facility failed to ensure that a criminal history record report is obtained, on or prior to the 30th day of employment, for each employee. Evidence: The record for Staff #6 (hired 3/2/23) contained a criminal history report from a private company. No criminal history report was provided for Staff #6, during the inspection, that was completed by the Virginia State Police.

Based on documentation, the facility failed to ensure that all information is documented on the medication administration record ( MAR

Based on observation and interview, the facility failed to ensure that PRN

Based on observation, the facility failed to ensure that a medicine cabinet, container, or compartment is used for the storage of medications and that the storage area remains locked. Evidence: The fourth-floor associate office was observed to be unlocked and unattended at 8:53 AM on 8/8/23. The medication cart was being kept in the office, and the cart was not locked.

Based on documentation, the facility failed to ensure that fire and emergency evacuation drill frequency is in accordance with the current edition of the Virginia Statewide Fire Prevention Code (13VAC5-51). The drills required for each shift in a quarter shall not be conducted in the same month. Evidence: Fire drill reports were requested during the inspection. No fire drill was documented for the third shift within the quarter. The most recent fire drill, that was documented for the third shift, was conducted on 3/10/23.

Based on documentation, the facility failed to implement a semi-annual review on the emergency preparedness and response plan for all staff, residents, and volunteers, with emphasis placed on an individual's respective responsibilities. Evidence: Documentation of the last review of the emergency preparedness and response plan was requested during the inspection. No information was provided, during the inspection, to document that a review of the emergency preparedness and response plan was conducted with all staff, residents, and volunteers.

Based on documentation, the facility failed to ensure that at least every six months, all staff currently on duty on each shift, participate in an exercise in which the procedures for resident emergencies are practiced. Evidence: Documentation of the last resident emergency exercise was requested during the inspection. No information was provided, during the inspection, to document that an exercise was conducted to practice the procedures for resident emergencies within the past six months.

Based on record review and interview, the facility failed to provide supervision of resident schedules, care, and activities including attention to specialized needs, such as wandering from the premises. Evidence: Resident #9 resided on the facility?s secure unit in June 2023. Resident #9?s record contained an assessment of serious cognitive impairment, dated 1/10/23, that states that Resident #1 has a serious cognitive impairment with an inability to recognize danger or protect his own safety and welfare. On 6/17/23, Resident #9 eloped from the special care unit. Law enforcement was contacted and she was located several blocks away from the facility and without staff supervision.

Based on record review and documentation, the facility failed to ensure that personal assistance and care are provided to each resident as necessary so that the needs of the resident are met, including assistance or care with: Bathing - at least twice a week, but more often if needed; and Dressing. Evidence: Resident #1's care documentation was observed during the inspection. Resident #1's individualized service plan ( ISP

Violation cited

Based on documentation review and interview facility failed to ensure that each direct care staff member maintains current certification in first aid. Evidence: Staff #2 hired on 3/28/2022 does not have documentation that First Aid training has been completed.

Based on observation and interview the facility failed to ensure that the facility act in accordance with General Procedures and Information for Licensure. Evidence: Upon Licensing Inspector?s arrival the most recent inspection results were not posted.