11 health deficiencies
Top issue: Quality of Life and Care (4 deficiencies)
1 fire-safety deficiencies
Top issue: Emergency Preparedness (1 deficiency)
Alexandria, VA
4-star overall rating with 3-star inspections with 11 recent health deficiencies with 1 fire-safety deficiencies in the latest cycle
1510 Collingwood Road, Alexandria, VA
(703) 765-6107
Overall
4 / 5
CMS overall stars
Health inspections
3 / 5
Survey and complaint cycles
Staffing
2 / 5
RN + nurse staffing
Quality measures
5 / 5
Resident outcomes and process measures
Quick facts
Beds
96
Certified beds
Average residents
84
Average occupied residents
Ownership
For-Profit
Publicly displayed owner type
Chain
Hill Valley Healthcare
Operator or chain grouping
Approved since
1967-01-01
CMS approved date
Coverage
Medicare + Medicaid
Participation flags
Chain footprint
40 facilities
Chain averages 2 overall / 2 health / 2 staffing / 4 quality stars
Changed ownership
No
Within the last 12 months
Family council
Yes
Resident and family council reported
Sprinklers
Yes
Automatic sprinklers in all required areas
Staffing
RN hours / resident day
0.40
Registered nurse staffing · state 0.69 · national 0.68
LPN hours / resident day
1.10
Licensed practical nurse staffing · state 1.00 · national 0.87
Aide hours / resident day
1.86
Nurse aide staffing · state 2.12 · national 2.35
Total nurse hours
3.36
All reported nurse hours · state 3.81 · national 3.89
Licensed hours
1.50
RN + LPN hours · state 1.68 · national 1.54
Weekend hours
3.00
Weekend nurse staffing · state 3.31 · national 3.43
Weekend RN hours
0.23
Weekend registered nurse coverage · state 0.46 · national 0.47
Physical therapist
0.11
Reported PT staffing · state 0.09 · national 0.07
Adjusted RN hours
0.39
CMS adjusted RN staffing hours
Adjusted total hours
3.26
CMS adjusted total nurse staffing hours
Case-mix index
1.41
Higher values indicate more complex resident acuity
RN turnover
54%
Annual RN turnover · state 49% · national 45%
Total nurse turnover
25%
Annual nurse turnover · state 48% · national 46%
SNF VBP
Program rank
2,003
Lower is better among SNFs in the FY 2026 VBP program.
Performance score
52.36
Composite VBP score used to determine payment impact.
Payment multiplier
1.0069
Above 1.000 increases Medicare payment; below 1.000 reduces it.
Program components
Readmission
6.13
Baseline 24.34% · Performance 19.49% · Measure score 6.13 · Achievement 4.18 · Improvement 6.13
Healthcare-associated infections
6.71
Baseline 12.04% · Performance 6.96% · Measure score 6.71 · Achievement 2.92 · Improvement 6.71
Total nurse turnover
8.10
Baseline 16.67% · Performance 30.56% · Measure score 8.10 · Achievement 8.10 · Improvement 0
Adjusted total nurse staffing
0
Baseline 3.69 hours · Performance 3.21 hours · Measure score 0 · Achievement 0 · Improvement 0
SNF QRP
| Measure | Facility | National | Note |
|---|---|---|---|
| Potentially preventable 30-day readmission | 12.39% |
10.72%
1.7 pts worse
|
No Different than the National Rate · Eligible stays 207 · Observed rate 14.01% · Lower 95% interval 9.24% |
| Discharge to community | 57.13% |
50.57%
6.6 pts better
|
No Different than the National Rate · Eligible stays 200 · Observed rate 51.5% · Lower 95% interval 49.02% |
| Medicare spending per beneficiary | 0.9 |
1.02
0.1 pts better
|
|
| Drug regimen review with follow-up | 96.81% |
95.27%
1.5 pts better
|
Numerator 91 · Denominator 94 |
| Falls with major injury | 0% |
0.77%
0.8 pts better
|
Numerator 0 · Denominator 94 |
| Discharge self-care score | 33.87% |
53.69%
19.8 pts worse
|
Numerator 21 · Denominator 62 |
| Discharge mobility score | 59.68% |
50.94%
8.7 pts better
|
Numerator 37 · Denominator 62 |
| Pressure ulcers or injuries, new or worsened | 1.06% |
2.29%
1.2 pts better
|
Numerator 1 · Denominator 94 · Adjusted rate 0.85% |
| Healthcare-associated infections requiring hospitalization | 6.96% |
7.12%
0.2 pts better
|
No Different than the National Rate · Eligible stays 84 · Observed rate 7.14% · Lower 95% interval 4.41% |
| Staff COVID-19 vaccination coverage | 0% |
8.2%
8.2 pts worse
|
Numerator 0 · Denominator 132 |
| Staff flu vaccination coverage | 58.52% |
42%
16.5 pts better
|
Numerator 79 · Denominator 135 |
| Discharge function score | 51.61% |
56.45%
4.8 pts worse
|
Numerator 32 · Denominator 62 |
| Transfer of health information to provider | 96.55% |
95.95%
0.6 pts better
|
Numerator 28 · Denominator 29 |
| Transfer of health information to patient | 80% |
96.28%
16.3 pts worse
|
Numerator 44 · Denominator 55 |
| Resident COVID-19 vaccinations up to date | 45.83% |
25.2%
20.6 pts better
|
Numerator 22 · Denominator 48 |
Quality measures
| Measure | Facility | State | National | Note |
|---|---|---|---|---|
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 93.1% |
91.2%
1.9 pts better
|
93.4%
0.3 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 98.6% · Q2 91.9% · Q3 93.1% · Q4 89.0% · 4Q avg 93.1% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine | 92.4% |
94.0%
1.6 pts worse
|
95.5%
3.1 pts worse
|
Long Stay · 2024Q3-2025Q2 · 4Q avg 92.4% |
| Percentage of long-stay residents experiencing one or more falls with major injury | 0.0% |
3.6%
3.6 pts better
|
3.3%
3.3 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.0% · Used in QM five-star |
| Percentage of long-stay residents who have depressive symptoms | 18.9% |
15.7%
3.2 pts worse
|
11.4%
7.5 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 11.1% · Q2 15.2% · Q3 20.9% · Q4 27.5% · 4Q avg 18.9% |
| Percentage of long-stay residents who lose too much weight | 0.4% |
5.7%
5.3 pts better
|
5.4%
5 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 1.6% · 4Q avg 0.4% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 14.3% |
20.2%
5.9 pts better
|
19.6%
5.3 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 10.6% · Q2 12.3% · Q3 14.3% · Q4 20.3% · 4Q avg 14.3% |
| Percentage of long-stay residents who received an antipsychotic medication | 6.1% |
15.0%
8.9 pts better
|
16.7%
10.6 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 2.1% · Q2 7.8% · Q3 6.4% · Q4 7.8% · 4Q avg 6.1% · Used in QM five-star |
| Percentage of long-stay residents who were physically restrained | 0.0% |
0.2%
0.2 pts better
|
0.1%
0.1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.0% |
| Percentage of long-stay residents whose ability to walk independently worsened | 24.9% |
17.5%
7.4 pts worse
|
16.3%
8.6 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q2 42.8% · Q3 14.4% · Q4 20.8% · 4Q avg 24.9% · Used in QM five-star |
| Percentage of long-stay residents whose need for help with daily activities has increased | 8.4% |
15.7%
7.3 pts better
|
14.9%
6.5 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 11.3% · Q2 14.1% · Q3 3.3% · Q4 4.8% · 4Q avg 8.4% · Used in QM five-star |
| Percentage of long-stay residents with a catheter inserted and left in their bladder | 0.3% |
0.5%
0.2 pts better
|
1.0%
0.7 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 1.1% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.3% · Used in QM five-star |
| Percentage of long-stay residents with a urinary tract infection | 1.4% |
1.6%
0.2 pts better
|
1.7%
0.3 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 1.5% · Q2 0.0% · Q3 0.0% · Q4 4.1% · 4Q avg 1.4% · Used in QM five-star |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | 24.6% |
22.2%
2.4 pts worse
|
19.8%
4.8 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 26.6% · Q2 23.6% · Q3 33.2% · Q4 15.2% · 4Q avg 24.6% |
| Percentage of long-stay residents with pressure ulcers | 3.2% |
5.2%
2 pts better
|
5.1%
1.9 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 5.0% · Q2 2.9% · Q3 3.0% · Q4 1.9% · 4Q avg 3.2% · Used in QM five-star |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 44.1% |
74.6%
30.5 pts worse
|
81.7%
37.6 pts worse
|
Short Stay · 2024Q4-2025Q3 · Q1 57.0% · Q2 39.2% · Q3 38.8% · Q4 40.8% · 4Q avg 44.1% |
| Percentage of short-stay residents who had an outpatient emergency department visit | 9.6% |
11.7%
2.1 pts better
|
12.0%
2.4 pts better
|
Short Stay · 20240701-20250630 · Adjusted 9.6% · Observed 9.9% · Expected 11.4% · Used in QM five-star |
| Percentage of short-stay residents who newly received an antipsychotic medication | 0.0% |
1.2%
1.2 pts better
|
1.6%
1.6 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.0% · Used in QM five-star |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 39.2% |
73.6%
34.4 pts worse
|
79.7%
40.5 pts worse
|
Short Stay · 2024Q3-2025Q2 · 4Q avg 39.2% |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission | 29.2% |
22.0%
7.2 pts worse
|
23.9%
5.3 pts worse
|
Short Stay · 20240701-20250630 · Adjusted 29.2% · Observed 28.2% · Expected 23.0% · Used in QM five-star |
Survey summary
Top issue: Quality of Life and Care (4 deficiencies)
1 fire-safety deficiencies
Top issue: Emergency Preparedness (1 deficiency)
Top issue: Quality of Life and Care (5 deficiencies)
3 fire-safety deficiencies
Top issue: Smoke (2 deficiencies)
Top issue: Freedom from Abuse and Neglect and Exploitation (4 deficiencies)
8 fire-safety deficiencies
Top issue: Egress (2 deficiencies)
Fire safety
Fire Safety
Conduct testing and exercise requirements.
Corrected 2023-07-18
Fire Safety
Have approved installation, maintenance and testing program for fire alarm systems.
Corrected 2022-03-09
Fire Safety
Ensure that corridors are separated from use areas by walls constructed to limit the passage of smoke.
Corrected 2022-03-09
Fire Safety
Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing.
Corrected 2022-03-09
Fire Safety
Keep aisles, corridors, and exits free of obstruction in case of emergency.
Corrected 2020-04-15
Fire Safety
Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.
Corrected 2020-04-15
Fire Safety
Inspect, test, and maintain automatic sprinkler systems.
Corrected 2020-04-15
Fire Safety
Provide a written emergency evacuation plan.
Corrected 2020-04-15
Fire Safety
Have generator or other power source capable of supplying service within 10 seconds.
Corrected 2020-04-15
Fire Safety
Ensure proper usage of power strips and extension cords.
Corrected 2020-04-15
Fire Safety
Develop a communication plan.
Corrected 2019-11-24
Fire Safety
Conduct testing and exercise requirements.
Corrected 2019-11-24
Inspection history
Health
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Corrected 2024-09-06
Health
Provide and implement an infection prevention and control program.
Corrected 2024-09-06
Health
Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions.
Corrected 2024-09-06
Health
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Corrected 2024-09-06
Health
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Corrected 2024-09-06
Health
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
Corrected 2023-10-09
Health
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Corrected 2023-10-09
Health
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Corrected 2023-12-04
Health
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected 2023-12-04
Health
Provide or obtain x-rays/tests when ordered and promptly tell the ordering practitioner of the results.
Corrected 2023-12-04
Health
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Corrected 2023-12-04
Health
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Corrected 2023-07-18
Health
Provide for the safe, appropriate administration of IV fluids for a resident when needed.
Corrected 2023-07-18
Health
Provide safe, appropriate pain management for a resident who requires such services.
Corrected 2023-07-18
Health
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
Corrected 2023-07-18
Health
Ensure each resident’s drug regimen must be free from unnecessary drugs.
Corrected 2023-07-18
Health
Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.
Corrected 2023-07-18
Health
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
Corrected 2023-07-18
Health
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Corrected 2023-07-18
Health
Provide safe and appropriate respiratory care for a resident when needed.
Corrected 2023-07-18
Health
Employ or obtain outside professional resources to provide services in the nursing home when the facility does not employ a qualified professional to furnish a required service.
Corrected 2023-07-18
Health
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Corrected 2023-07-18
Health
Provide safe, appropriate dialysis care/services for a resident who requires such services.
Corrected 2022-02-24
Health
Reasonably accommodate the needs and preferences of each resident.
Corrected 2022-02-24
Health
Keep residents' personal and medical records private and confidential.
Corrected 2022-02-24
Health
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
Corrected 2022-02-24
Health
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Corrected 2022-02-24
Health
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Corrected 2022-02-24
Health
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
Corrected 2022-02-24
Health
Provide safe, appropriate pain management for a resident who requires such services.
Corrected 2022-02-24
Health
Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail.
Corrected 2022-02-24
Health
Ensure each resident’s drug regimen must be free from unnecessary drugs.
Corrected 2022-02-24
Health
Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.
Corrected 2022-02-24
Health
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected 2019-11-24
Health
Provide and implement an infection prevention and control program.
Corrected 2019-11-24
Health
Make sure that a working call system is available in each resident's bathroom and bathing area.
Corrected 2019-11-24
Health
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
Corrected 2019-11-24
Health
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Corrected 2019-11-24
Health
Ensure each resident receives an accurate assessment.
Corrected 2019-11-24
Health
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Corrected 2019-11-24
Health
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected 2019-11-24
Health
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected 2019-11-24
Health
Observe each nurse aide's job performance and give regular training.
Corrected 2019-11-24
Health
Ensure each resident’s drug regimen must be free from unnecessary drugs.
Corrected 2019-11-24
Health
Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention.
Corrected 2019-11-24
Penalties and ownership
5% Or Greater Direct Ownership Interest · Organization
5% Or Greater Indirect Ownership Interest · Organization
5% Or Greater Indirect Ownership Interest · Organization
Corporate Officer · Individual
5% Or Greater Indirect Ownership Interest · Organization
W-2 Managing Employee · Individual
5% Or Greater Indirect Ownership Interest · Organization
5% Or Greater Indirect Ownership Interest · Organization
5% Or Greater Indirect Ownership Interest · Organization
5% Or Greater Indirect Ownership Interest · Organization
Nearby options
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Fort Washington, MD
4-star overall rating with 3-star inspections with $7,443 in total fines with 18 recent health deficiencies with 6 fire-safety deficiencies in the latest cycle
Alexandria, VA
5-star overall rating with 4-star inspections with 2 recent health deficiencies
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