Inspection Reports for
Tribute at One Loudoun by Cogir
20335 Savin Hill Dr, Ashburn, VA 20147, United States, VA, 20147
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Inspection Reports Summary
Covers 37 inspections · Nov 2020 – Apr 2026Visit Reason
This report covers 37 inspections of Tribute at One Loudoun from November 20, 2020 to April 14, 2026 by the Virginia Department of Social Services, including complaint and routine inspections.
Complaint Details
Multiple complaint surveys were conducted, with 18 inspections prompted by complaints. Complaints involved allegations in areas such as resident care, staffing and supervision, resident accommodations, and additional requirements for adults with serious cognitive impairments. Some complaints were substantiated with violations issued; others were not supported by evidence.
Findings
Across that history VDSS cited 103 violations under 63 distinct standards. 26 of 37 visits ended with violations cited and 11 with none. 18 inspections were prompted by a complaint.
Violations (51)
22VAC40-73-450-C: ISP not completed within 30 days and lacked required service descriptions and dates.
22VAC40-73-290-B: Facility failed to ensure conspicuous posting of current on-site person in charge.
22VAC40-73-640-A: Medication management plan not current or fully implemented, causing transcription errors.
22VAC40-73-650-B: Physician orders lacked required details including diagnosis and administration instructions.
22VAC40-73-440-A: Residents and applicants not assessed face to face using UAI at admission, annually, or with condition changes.
22VAC40-73-680-H: Medication administrations not documented on MAR at time of administration.
22VAC40-73-680-D: Medication not administered according to physician or prescriber instructions.
22VAC40-73-650-A: Medication or treatment started, changed, or discontinued without valid physician or prescriber order.
22VAC40-73-680-C: Medications administered earlier than one hour before or later than one hour after scheduled time.
22VAC40-73-460-H: Personal assistance and care not provided to meet resident needs including bathing and toileting.
22VAC40-73-130-A: Mandated reporters failed to report suspected abuse, neglect, or exploitation of residents.
22VAC40-73-460-B: Care and service delivery not resident centered with delayed staff response to resident needs.
22VAC40-73-440-A: UAI not completed at admission, annually, as needed, or for significant change in condition.
22VAC40-73-450-F: ISP not reviewed and updated annually or as needed for significant change in condition.
22VAC40-73-480-E: Physician orders, services, evaluations, and progress not recorded in resident record.
22VAC40-73-520-I: Written schedule of activities not maintained or updated to reflect changes.
22VAC40-73-1120-F: No designated qualified person responsible for structured activities in safe, secure unit.
22VAC40-73-520-G: Staff or volunteer leading activities lacked understanding of resident needs and activity adaptation.
22VAC40-73-1030-A: Minimum awake and on duty direct care staffing not ensured in special care unit per census.
22VAC40-73-1140-E: Staff outside administrator and direct care failed to complete required dementia training.
22VAC40-73-870-B: Building had foul and musty odors, especially in memory care unit hallway.
22VAC40-73-870-A: Buildings and grounds not maintained in good repair; floorboards peeling with water damage.
22VAC40-73-260-A: Staff lacked current certification in first aid from approved organizations.
22VAC40-73-650-B: Physician orders missing diagnosis, condition, or indication for administration.
22VAC40-73-50-A: Disclosure statement not prepared on department form or provided to prospective resident/legal rep.
22VAC40-73-200-C: Direct care staff lacked required qualifications upon hire or within two months.
22VAC40-73-680-I: MAR did not include all 13 required components including specific indications for meds.
22VAC40-73-680-D: Medication not administered per physician orders and standards of practice.
22VAC40-73-450-E: ISP not signed and dated by licensee/administrator/designee and resident or legal rep.
22VAC40-73-280-A: Staffing insufficient in numbers to provide services to maintain resident well-being.
22VAC40-73-460-D: Failed to ensure supervision of specialized needs such as fall prevention.
22VAC40-73-40-A: Failed to comply with facility policies and procedures regarding change in condition reporting.
22VAC40-73-660-A: Medication and dietary supplement storage area not locked.
22VAC40-73-270-1: Direct care staff not trained in managing residents with aggressive behavior prior to care.
22VAC40-73-680-E: Treatments ordered by physician or prescriber not provided according to orders.
22VAC40-73-560-E: Resident records not kept in locked area.
22VAC40-73-720-A: Valid written DNR order not included in individualized service plan.
22VAC40-73-680-C: Medications administered outside one hour before or after scheduled dosing time.
22VAC40-73-680-H: MAR did not document all medications administered at time of administration.
22VAC40-73-680-I: MAR did not include initials of direct care staff administering medications.
22VAC40-73-460-A: Failed to provide adequate care to protect health, safety, and well-being of residents.
22VAC40-73-280-B: Written staffing plan specifying number and type of direct care staff not maintained.
22VAC40-73-50-B: Written acknowledgement of receipt of disclosure by resident or legal rep not retained.
22VAC40-73-600-B: Less than four hours between breakfast and lunch meals.
22VAC40-73-530-C: Residents lacked freedom of movement between common areas and personal spaces.
22VAC40-73-860-I: Hazardous materials not stored in locked area.
22VAC40-73-310-M: Hospice agreement not in place between facility and hospice program providing care.
22VAC40-73-450-C: ISP did not include written description of services to address identified needs.
22VAC40-73-720-A: Written DNR order not included in resident's ISP.
22VAC40-73-600-A: Time between evening and breakfast meals exceeded 15 hours.
22VAC40-73-260-A: Staff lacked current certification in first aid.
Report Facts
Violations cited: 103
Distinct standards: 63
Inspections on page: 37
Inspections with violations: 26
Complaint visits: 18
Employees mentioned
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