Inspection Reports for
Marian Manor of Stafford
177 Old Potomac Church Road, STAFFORD, VA, 22554-7258
Back to Facility ProfileDeficiencies (last 4 years)
Deficiencies (over 4 years)
1.5 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
84% better than Virginia average
Virginia average: 9.1 deficiencies/year
Deficiencies per year
8
6
4
2
0
Census
Latest occupancy rate
39 residents
Based on a May 2025 inspection.
Occupancy over time
Inspection Report
Complaint Investigation
Census: 39
Deficiencies: 1
Date: May 20, 2025
Visit Reason
The inspection was conducted due to a complaint received on 2025-03-15 regarding allegations in the areas of resident care, staffing, and supplies.
Complaint Details
The complaint was not substantiated based on the evidence gathered during the investigation.
Findings
The investigation did not substantiate the complaint allegations; however, a violation unrelated to the complaint was identified concerning inadequate personal assistance with bathing for a resident.
Deficiencies (1)
The facility failed to ensure that personal assistance and care are provided to each resident as necessary, including assistance with bathing at least twice a week as specified in the resident's Individualized Service Plan.
Report Facts
Number of residents present: 39
Number of resident records reviewed: 3
Number of staff records reviewed: 0
Number of resident interviews conducted: 1
Number of staff interviews conducted: 3
Number of documented showers in May 2025 for resident 3: 2
Days allowed for plan of correction submission: 5
Days allowed for review request: 15
Inspection Report
Monitoring
Census: 37
Deficiencies: 5
Date: Nov 25, 2024
Visit Reason
The inspection was a monitoring visit conducted on November 25 and 26, 2024, to review compliance with applicable standards and laws at Marian Manor of Stafford.
Findings
The inspection found multiple violations related to staff orientation and training, documentation of direct care staff qualifications, employee health records, pet policy, and documentation of resident rounds. Plans of correction were provided for each violation to ensure future compliance.
Deficiencies (5)
Failed to ensure orientation and training of new staff occurred within the first seven working days of employment.
Failed to obtain and retain documentation indicating that direct care staff met requirements to be a direct care provider.
Failed to ensure employee health information, including tuberculosis examination reports, was maintained in staff records.
Failed to maintain a policy regarding pets living on the premises that ensured safety and well-being of residents and staff.
Failed to document rounds for each resident with an inability to use the signaling device.
Report Facts
Number of residents present: 37
Number of resident records reviewed: 4
Number of staff records reviewed: 3
Number of staff interviews conducted: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff 1 | Interviewed and involved in findings related to staff orientation, direct care staff documentation, employee health records, pet policy, and resident rounds documentation | |
| Staff 3 | Staff member whose orientation and training documentation was missing | |
| Staff 4 | Staff member whose direct care provider documentation and tuberculosis exam report were missing |
Inspection Report
Monitoring
Census: 35
Deficiencies: 0
Date: Feb 21, 2024
Visit Reason
The inspection was a monitoring visit to review various areas including administration, personnel, staffing, resident care, buildings and grounds, and emergency preparedness.
Findings
The Licensing Inspector reviewed records, conducted interviews, observed residents during activities and meals, and examined fire drills, menus, activity calendars, physical plant, and healthcare oversight. All facility self-reported incidents since the last inspection were reviewed.
Report Facts
Records reviewed: 8
Interviews conducted: 7
Inspection Report
Renewal
Census: 37
Deficiencies: 0
Date: Jan 20, 2023
Visit Reason
The inspection was conducted as a renewal inspection to review compliance with licensing requirements and facility operations.
Findings
The Licensing Inspector reviewed multiple areas including administration, personnel, resident care, emergency preparedness, and additional requirements for adults with serious cognitive impairment. The inspection included review of fire drills, dietician report, pharmacy review, and health care oversight, with no complaint-related issues noted.
Report Facts
Resident records reviewed: 4
Staff records reviewed: 4
Interviews conducted: 5
Inspection Report
Monitoring
Census: 38
Deficiencies: 0
Date: Mar 21, 2022
Visit Reason
The inspection was a monitoring visit to review personnel, staffing and supervision, admission, retention and discharge of residents, and resident care and related services at Marian Manor of Stafford.
Findings
The inspection included review of resident and staff records, interviews, observation of residents during lunch and activities, and review of pharmacy, dietician, and health care oversight reports. No complaint was related to this visit.
Report Facts
Records reviewed: 6
Interviews conducted: 5
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