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Source: VA State Licensing Agency
Renewal Inspection Date of Inspection: 12/16/2025 9:30am - 4:30pm The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. Number of residents present at the facility at the beginning of the inspection: 6 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 2 Number of staff records reviewed: 2 Number of interviews conducted with residents: 1 Number of interviews conducted with staff: 4 Observations by licensing inspector: LI observed the residents preparing to go on a community outing and lunch. An exit meeting will be conducted to review the inspection findings. The evidence gathered during the inspection determined non-compliance with applicable standard(s) or law, and violation(s) were documented on the violation notice issued to the facility. The licensee has the opportunity to submit a plan of correction to indicate how the cited violation(s) will be addressed in order to return the facility to compliance and maintain future compliance with applicable standard(s) or law. If the licensee wishes to provide a plan of correction: (i) type the plan on a separate Word document, (ii) identify the standard violation number being addressed, (iii) include the date the violation will be corrected, (IV) do not include any names or confidential information, and (V) return to the licensing inspector by email within five (5) business days of the exit interview. Compliance with all applicable regulations and law shall be maintained and any areas of noncompliance must be corrected. Within 15 calendar days of your receipt of the inspection findings (inspection summary, violation notice, and supplemental information), you may request a review and discussion of these findings with the inspector's immediate supervisor. To make a request for review and discussion, you must contact the licensing supervisor at the regional licensing office that serves your geographical area. Regardless of whether a supervisory review has been requested, the results of the inspection will be posted to the DSS public website within 5 business days of your receipt of the Inspection Summary and/ or Violation Notice. The department's inspection findings are subject to public disclosure. Please Note: A copy of the findings of the most recent inspection are required to be posted on the premises of a licensed facility. For more information about the VDSS Licensing Programs, please visit: www.dss.virginia.gov Should you have any questions, please contact Alexandra Roberts, Licensing Inspector at 804-845-6956 or by email at Alexandra.n.roberts@dss.virginia.gov.
Based on record review, the facility failed to ensure a valid physician's or other prescriber's order that includes the oxygen source, such as compressed gas or concentrators. Evidence: 1. Resident 2?s record contained order dated on 02/20/2025 for ?DC 2L/min NC Oxygen? and start ?3L/min NC oxygen continuous.? 2. Resident 2?s record contained order signed 07/09/2025 for ?give 3 liters via nasal canula continuously?. 3. Resident 2?s record contained order signed 11/04/2025 for ?give 4 liters via nasal canula continuously?. 4. Staff 5 acknowledged that Resident 2?s oxygen order did not contain the oxygen source. 5. Photo evidence obtained.
Based on record review and staff interview, the facility failed to ensure that the fall risk rating shall be reviewed and updated after a fall. Evidence: 1. Resident 1?s record contained incident reports dated 12/08/2025 that Resident 1 had a fall. 2. Staff 5 provided Resident 1?s most recent fall risk assessment dated 12/01/2025. 3. Staff 5 confirmed the facility does not have an updated fall risk rating for the 12/08/2025 fall sustained by Resident 1.
Based on interview, the facility failed to ensure annual contact with the local emergency coordinator to determine (i) local disaster risks, (ii) communitywide plans to address different disasters and emergency situations, and (iii) assistance, if any, that the local emergency management office will provide to the facility in an emergency. Evidence: 1. During the onsite inspection on 12/16/2025, licensing staff requested documentation of annual contact with the local emergency coordinator. 2. Staff 4 confirmed that contact has not been made with the local emergency coordinator.
Based on record review and staff interview, the facility failed to report to the regional licensing office within 24 hours any major incident that has negatively affected or that threatens the life, health, safety, or welfare of any resident. Evidence: 1. Resident 1?s record contained an incident report that was dated 10/20/2025 indicating that Resident 1 was hospitalized following a fall. Licensing staff did not receive an incident report within 24 hours. 2. Resident 1?s record contained incident report documented on 12/15/2025 indicating that Resident 1 fell on 11/30/2025 and was ?bleeding profusely? from their head resulting in 911 being called. Licensing staff did not receive an incident report within 24 hours. 3. Staff 4 confirmed that incident reports were not sent to the licensing office or representative for the identified incidents with Resident 1.
Based on interview, the facility failed to ensure the 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. The review shall be documented by signing and dating. Evidence: 1. During the onsite inspection on 12/16/2025, Staff 4 confirmed the facility has not completed a semi-annual review of emergency preparedness and response plan for all staff and residents.
Based on observation and staff interview, the facility failed to ensure that doors leading to the outside shall not be locked from the inside or secured from the inside in any manner that amounts to a lock. Evidence: 1. Licensing staff observed both front and back entry doors having a numerical keypad lock to enter and to leave the facility. 2. Staff 1 was observed going in the front entry door and the back door requiring the code to be entered. Staff 1 confirmed that both doors have a numerical pad lock that is always in use to get in and out of the facility. 3. Staff 4 confirmed that the doors have locks on the doors and that only facility staff have the code. 4. Video evidence obtained.
Based on observation and interview, the facility failed to store cleaning supplies and other hazardous materials in a locked area. Evidence: 1. During facility tour on 12/16/2025, licensing staff observed in the first-floor common bathroom sink cabinet unsecured Mr. Clean cleaning spray and disinfectant wipes. 2. During facility tour on 12/16/2025, licensing staff observed in the second-floor closet, dishwasher pods, dawn dish soap, and MicroBan disinfectant spray. 3. Staff 4 confirmed that the unsecured cleaning supplies on the first-floor bathroom and in the second-floor closet. 4. Photo evidence obtained.
Based on observation and interview, the facility failed to post "No Smoking-Oxygen in Use" signs and enforce the smoking prohibition in any room of a building where oxygen is in use. Evidence: 1. During the onsite inspection on 12/16/2025, Resident 2 was observed using oxygen in their room and during lunch in the dining room. 2. During facility tour, licensing staff did not observe "No Smoking-Oxygen in Use" signs in their room or the common area. 3. Staff 4 and Staff 5 confirmed that there is currently no sign of oxygen use posted within or outside of the facility at time of inspection.
Type of Inspection: Monitoring Inspection Date of Inspection: 6-24-2024 - 8am - 2:30pm The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. Number of residents present at the facility at the beginning of the inspection: 8 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 2 Number of staff records reviewed: 4 Number of interviews conducted with residents: 2 Number of interviews conducted with staff: 3 Observations by licensing inspector: The LI observed medication administration, residents eating lunch and participating in other scheduled activities. An exit meeting will be conducted to review the inspection findings. The evidence gathered during the inspection determined non-compliance with applicable standard(s) or law, and violation(s) were documented on the violation notice issued to the facility. The licensee has the opportunity to submit a plan of correction to indicate how the cited violation(s) will be addressed in order to return the facility to compliance and maintain future compliance with applicable standard(s) or law. If the licensee wishes to provide a plan of correction: (i) type the plan on a separate Word document, (ii) identify the standard violation number being addressed, (iii) include the date the violation will be corrected, (IV) do not include any names or confidential information, and (V) return to the licensing inspector by email within five (5) business days of the exit interview. Compliance with all applicable regulations and law shall be maintained and any areas of noncompliance must be corrected. Within 15 calendar days of your receipt of the inspection findings (inspection summary, violation notice, and supplemental information), you may request a review and discussion of these findings with the inspector's immediate supervisor. To make a request for review and discussion, you must contact the licensing supervisor at the regional licensing office that serves your geographical area. Regardless of whether a supervisory review has been requested, the results of the inspection will be posted to the DSS public website within 5 business days of your receipt of the Inspection Summary and/ or Violation Notice. The department's inspection findings are subject to public disclosure. Please Note: A copy of the findings of the most recent inspection are required to be posted on the premises of a licensed facility. For more information about the VDSS Licensing Programs, please visit: www.dss.virginia.gov Should you have any questions, please contact Alexandra Roberts, Licensing Inspector at 804-845-6956 or by email at Alexandra.n.roberts@dss.virginia.gov.
Based on record review and staff interview, facility failed to document on the ISP
Based on record review and staff interview, facility failed to provide and document orientation for new residents. Evidence: 1. Resident 1 and Resident 2 charts were reviewed with no documentation in record acknowledging orientation. 2. LI requested from Staff 1 who stated that she does not know what that documentation is. Staff 1 asked Staff 3. Staff 3 stated that they review with resident and family, but they do not have documentation for it.
Based on observation and staff interview, facility failed to post the telephone numbers for the fire department, rescue squad or ambulance, police, and Poison Control Center by each telephone shown on the fire and emergency evacuation plan. Evidence: 1. LI reviewed phones posted on evacuation map. The phones only had the facility phone number posted and Staff 2 confirmed the phone number to LI to be the facility phone number. None of the emergency contact numbers were posted by the phone. 2. Staff 1 stated that she did not know that the numbers are to be posted by all phones on the evacuation map. Staff 1 informed that they are posted in the nurse station with medication cart. 3. Staff 4 confirmed that she knew that they are to be posted and will make sure that is completed.
Based on record review and interview, facility failed to review the emergency preparedness plan annually or more often as needed, document the review by signing and dating the plan, and make necessary plan revisions. Such revisions shall be communicated to staff, residents, and volunteers. Evidence: 1. LI requested documentation of review for staff, residents, and volunteers. 2. Staff 1 confirmed that the facility does not have any documentation of any emergency preparedness plan review for staff or residents. 3. Staff 1 stated that she also checked with her supervisor who also did not have documentation of a review.
Based on record review and staff interview, facility failed to ensure annual tuberculosis evaluations. Evidence: 1. Resident 2?s record contained TB test dated as 08/26/2022. 2. LI requested more recent TB test. Staff 1 informed that she thought that only staff were to get annual TB test. Staff 1 reviewed online chart of resident 1 and confirmed that resident 1 does not have current TB evaluation completed.
22VAC40-73-350-C Based on record review and staff interview, facility failed to ensure that each resident or his legal representative is fully informed, prior to or at the time of admission and annually, that he should exercise whatever due diligence he deems necessary with respect to information on any sex offenders registered pursuant to Chapter 9 (? 9.1-900 et. seq.) of Title 9.1 of the Code of Virginia, including how to obtain such information with written acknowledgement maintained in the resident record. Evidence: 1. Resident 1 and Resident 2?s record did not have any acknowledgement or documentation in record. 2. Staff 1 stated that she does not know what that documentation would look like. Staff 1 stated that she asked her supervisors and stated they have not been completing this notification to residents or family.
Based on record review and staff interview, facility failed to ensure month first aid kits are checked at least monthly to ensure all items are present. Evidence: 1. LI requested evidence of monthly check of first aid kit. Staff 1 confirmed that facility does not have a monthly check or documentation and that facility has not been completing a monthly check.
Based on record review and staff interview, facility failed to ensure that each direct care staff shall maintain current certification in first aid from one of the recognized organizations. Evidence: 1. Staff 1?s (hired 5/27/2023) record contained current CPR certification with a completion date of 03/09/2023 by American Healthcare Academy, which is not an approved organization. 2. Staff 1 confirmed that she does not have another certification. 3. Staff 1 stated that she transferred from one of the companies Maryland facilities and did not know that Virginia has certain organizations that are approved.
Based on record review and staff interview, the facility failed to ensure compliance with the Virginia Statewide Fire Prevention Code (13VAC5-51) as determined by at least an annual inspection by the appropriate fire official. Evidence: 1. LI requested annual fire inspection. Staff 1 provided documentation of a ?Fire Alarm Inspection and Testing Form? conducted by Guardian Fire completed on 01/03/2024. 2. LI requested again the fire inspection from county fire official. Staff 1 provided another document from a 3rd party vendor. 3. Staff 1 stated that she asked her supervisor and called the administrative assistant who confirmed that the fire official has not come to complete an inspection. Staff 1 was able to provide a carbon copy of a county inspection dated to be 7/14/2022. 4. Staff 4 confirmed that the inspections have ?slipped through the cracks? and the ?fire official will come tomorrow?.
Based on observation and staff interview, facility failed to ensure resident rights is posted with the name and telephone number of the appropriate regional licensing supervisor of the department, the Adult Protective Services' toll-free telephone number, the toll-free telephone number of the Virginia Long-Term Care Ombudsman Program and any substate (i.e., local) ombudsman program serving the area, and the toll-free telephone number of the Disability Law Center of Virginia. Evidence: 1. Resident Rights was posted publicly but facility used their own formatting and edits made to the document did not include any of the required contact information for required officials. 2. Staff 1 stated that she did not know the contact information was to be posted on the posting. 3. LI showed Staff 1 a copy of VDSS Resident Rights for reference from online forms and staff 1 confirmed she didn?t know to list or post the contacts.
Based on record review and staff interview, the facility failed to develop written emergency procedures to address: Locating and shutting off utilities when necessary and building and site maps necessary to shut off utilities. Evidence: 1. LI reviewed emergency preparedness plan and there was no mention of shutting off utilities nor was there a map included or attached to indicate where to shut off utilities. 2. Staff 1 stated that the plan is the same plan used in the Maryland facilities and may require different requirements than Virginia that were missed. 3. Staff 1 confirmed that she does not have this information.
22VAC40-73-650-C Based on record review and staff interview, facility failed to ensure Physician's or other prescriber's oral orders are reviewed and signed by a physician or other prescriber within 14 days. Evidence: 1. Resident 1?s record contained oral order (written 6/10/2024) for Vitamin D3 50,000 weekly that was not signed on day of inspection. Staff 1 stated that the physician was not coming on-site during the day of inspection (6/24/2024) to sign order making it the 14th day with no signature. 2. Resident 1?s record contained oral order written 4/25/2024 by RN updating blood pressure parameters and medication. Order was signed on 05/17/2024. 3. Resident 1?s record contained oral order written 4/27/2024 by RN to D/C Pantoprazole. Order was signed on 05/17/2024. 4. Staff 1 stated that she did not know there was a requirement for physicians to sign orders in a certain timeframe.
22VAC40-73-980-A Based on observation and staff interview, the facility failed to ensure a complete first aid kit is on hand. Evidence: 1. First aid kit on hand did not include: Tape, disposable blankets, roller gauze, plastic bags, scissors, flashlight, batteries, thermometer. The kit only had 1 sample size of hand cleaner. 2. Staff 1 stated that she did not know that additional items were needed for first aid kit on hand.
Type of inspection: Renewal An unannounced renewal inspection was conducted on 11/11/2022. At the time of entrance five residents were in care. Sample size consisted of three resident records and three staff records. Resident and staff records and other documentation were reviewed. Virginia State Police background checks reviewed for all new staff hired since the previous inspection. Residents were observed eating and engaging in activities. Medication administration was reviewed. An exit meeting was conducted to review the inspection findings. The evidence gathered during the inspection determined violation with applicable standard(s) or law. The inspection summary will be posted to the VDSS website within five (5) business days of your receipt of the inspection summary. The department's inspection findings are subject to public disclosure. Please Note: A copy of the findings of the most recent inspection are required to be posted on the premises of the facility For more information about the VDSS Licensing Programs, please visit: www.dss.virginia.gov Should you have any questions, please contact Tammy Pruitt, Licensing Inspector at (703) 314-0604 or by email at tammy.pruitt@dss.virginia.gov
A monitoring inspection was initiated on September 15, 2021 and concluded on September 16, 2021. The facility owner was contacted by email to initiate the inspection. The owner reported that the current census was eight. The inspector emailed the owner a list of items required to complete the remote documentation review portion of the inspection. The inspector reviewed two resident records, two staff records, staff training, staff schedules, licenses, fire drills and multiple required information submitted by the facility to ensure documentation was complete. The inspector conducted the on-site portion of the inspection on September 16, 2021. An exit interview was conducted with Owner and Administrator on the date of inspection, where findings were reviewed and an opportunity was given for questions, as well as for providing any information or documentation which was not available during the inspection. During this inspections there were no violations issued. If you have questions I can be reached at 703-314-0604
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