Inspection Reports for
Culpepper Garden III, INC
4439 N. Pershing Drive, ARLINGTON, VA, 22203
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Inspection Reports Summary
Covers 14 inspections · Jan 2021 – Aug 2025Visit Reason
This report covers 14 inspections of Culpepper Garden III, INC by the Virginia Department of Social Services between January 19, 2021 and August 26, 2025, including routine, renewal, monitoring, and complaint investigations.
Complaint Details
Three inspections were prompted by complaints regarding Quality of Care, Admission, Retention, and Discharge of Residents, and Buildings and Grounds. Investigations did not support allegations in two complaints and one complaint resulted in one violation related to pest infestations.
Findings
Across that history VDSS cited 20 violations under 20 distinct standards. 7 of the 14 inspections cited violations and 3 inspections were prompted by a complaint.
Deficiencies (20)
22VAC40-73-870-D: Facility failed to ensure buildings are free of insect infestations.
22VAC40-73-680-D: Medications not administered per physician's instructions and nursing standards.
22VAC40-73-250-B: Facility failed to have a staff record at the facility as required.
22VAC40-73-450-D: Facility failed to have coordinated plan of care between hospice agency and facility on ISP.
22VAC40-73-1040-A: Facility failed to ensure security monitoring of doors for residents with serious cognitive impairments.
22VAC40-73-280-B: Facility failed to have a written staffing plan related to resident acuity levels.
22VAC40-73-460-D: Facility failed to provide supervision of residents including those with wandering behavior.
22VAC40-73-450-F: ISP not reviewed and updated at least annually or as needed for significant changes.
22VAC40-73-550-F: Resident Rights and Responsibilities not posted conspicuously with correct contact info.
22VAC40-73-620-B: Action taken for oversight of special diets not documented in resident record.
22VAC40-73-650-C: Physician's oral orders not reviewed and signed within 14 days.
22VAC40-73-860-I: Cleaning supplies and hazardous materials not stored in locked area.
22VAC40-73-950-E: Facility failed to ensure semi-annual review of emergency preparedness plan.
22VAC40-73-950-F: Annual emergency preparedness plan review not documented by signature and date.
22VAC40-73-200-C: Direct care staff failed to meet required qualifications within two months of employment.
22VAC40-73-450-C: ISP not updated annually or as needed to include written description of services provided.
22VAC40-73-560-F: Facility failed to ensure all records are treated confidentially.
22VAC40-73-650-D: Medications not administered according to physician's instructions and nursing standards.
22VAC40-73-680-I: MAR did not include medication errors or omissions.
22VAC40-90-40-B: Criminal history record report not obtained within 30 days of employment.
Report Facts
Violations cited: 20
Distinct standards: 20
Inspections on page: 14
Inspections with violations: 7
Complaint visits: 3
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