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Source: VA State Licensing Agency
Type of inspection: Renewal Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: Date: 12/22/2025 Time In: 10am Time Out: 4:00pm 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: 7 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 engaging with one another and participating in 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 the record review and staff interview, the facility failed to ensure that the individualized service plan was signed and dated by the licensee, administrator, or his designee, (i.e., the person who has developed the plan), and by the resident or his legal representative. Evidence: 1. During onsite inspection on 12/22/2025 two LI?s observed 3 Individualized Service Plans ( ISP
Based on record review and staff interview, the facility failed to ensure that the rights and responsibilities of residents in assisted living facilities are reviewed annually with each resident or his legal representative or responsible individual. Evidence: 1. During the onsite inspection on 12/22/2025, Resident 1's record indicated Resident 1 was admitted to the facility on 07/01/2020 with the last review of rights and responsibilities of residents reviewed on 07/01/2020. 2. Staff #1 confirmed the rights and responsibilities of residents are not completed annually and the last review date for Resident 1 as 07/01/2020. 3. Photo Evidence Obtained.
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. During the onsite inspection on 12/22/2025, licensing staff observed both front and back entry doors having a numerical keypad lock to enter and to leave the facility. 2. Staff 1 confirmed that both doors have a numerical lock to get inside and outside of the facility. 3. Video evidence obtained.
Based on record review and interview, the facility failed to ensure each staff person or household member be evaluated annually and submit the results of a risk assessment, documenting that the individual is free of tuberculosis in a communicable form as evidenced by the completion of the current screening form published by the Virginia Department of Health or a form consistent with it. 22VAC40-73- 250 D Evidence: 1. During the onsite inspection on 12/22/2025, Staff 4's record indicated their hire date as 4/2/2021; however, Staff 4?s current TB risk assessment dated 09/17/2025 was not consistent with the current screening form published by the Virginia Department of Health (VDH) as it did not include the screening tool that assessed symptoms, exposure, travel, medical conditions, and health status. 2. Staff 1 acknowledged that Staff 4's TB risk assessment form dated 09/17/2025 is not consistent with the current screening form published by VDH. 3. Photo evidence has been obtained.
Based on the record review and staff interview, the facility failed to ensure that Do Not Resuscitate (DNR) Orders for withholding cardiopulmonary resuscitation from a resident in the event of cardiac or respiratory arrest may only be carried out in a licensed assisted living facility when: a valid written order has been issued by the resident's attending physician; and the written order is included in the individualized service plan. Evidence: 1. During the onsite inspection on 12/22/2025, LI?s observed that Resident 1?s ISP
Based on the record review, staff record review and staff interview, the facility failed to ensure that the licensee, administrator, or his designee who has successfully completed the department- approved individualized service plan ( ISP
Type of inspection: Monitoring Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 5/06/2025 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: 3 Number of interviews conducted with residents: 1 Number of interviews conducted with staff: 3 Observations by licensing inspector: Observed residents in the common area engaging with one another. Residents also went out on a field trip as an activity. Additional Comments/Discussion: None. 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 the 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, the facility failed to ensure that the facility's medication plan address procedures for administering medication to include Standard operating procedures, including the facility's standard dosing schedule and any general restrictions specific to the facility and methods to ensure accurate counts of all controlled substances whenever assigned medication administration staff changes and a plan for proper disposal of medication. Evidence: 1. LI reviewed Medication Management plan, and it was missing standard operating procedures, standard dosing schedule, methods to ensure accurate count of controlled substances and a plan of medication disposal. 2. Staff 2 confirmed that the procedures were not written or included in the medication management plan.
Based on record review and staff interview, the facility failed to ensure that for each resident with an inability to use the signaling device, in addition to any other services, the following be met: - The plan shall specify a minimal frequency of daily rounds to be made by direct care staff to monitor for emergencies or other unanticipated resident needs. - The facility shall document the rounds that were made, which shall include the name of the resident, the date and time of the rounds, and the staff member who made the rounds. The documentation shall be retained for two years. Evidence: 1. Resident 1 and Resident 2?s Individualized Service Plans ( ISP
Based on record review and staff interview, the facility failed to maintain a written plan that specifies the number and type of direct care staff required to meet the day-to-day, routine direct care needs and any identified special needs for the residents in care. This plan shall be directly related to actual resident acuity levels and individualized care needs. Evidence: 1. Staff 1 and Staff 3 confirmed that the facility does not maintain a written plan that specifies the number and type of direct care staff required to meet the day-to-day, routine direct care needs and any identified special needs for the residents in care.
Based on observation and staff interviews, the facility failed to ensure a listing of all staff who have a current certification in first aid or CPR, in conformance with subsections A and B of this section, be posted in the facility so that the information is readily available to all staff at all times. The listing must indicate by staff person whether the certification is in first aid or CPR or both and must be kept up to date. Evidence: 1. LI requested to be shown posting of all staff list who have current CPR and first aid certification. 2. Staff 1,2, & 3 confirmed that the facility does not have a list of all staff with CPR/first aid certification posted in the facility.
Based on observation and staff interview, the facility failed to implement a procedure for posting the name of the current on-site person in charge, as provided for in this chapter, in a place in the facility that is conspicuous to the residents and the public. Evidence: 1. During the onsite inspection on 05/06/2025, Staff 5 was posted as the current on-site person in charge; however, Staff 5 was not present at the facility and no longer employed at the facility for over 6 weeks.
Based on observation and staff interview, the 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 observed the phone in the kitchen only had the facility phone number taped on the phone. None of the emergency contact numbers were posted by the phone. 2. Photo evidence obtained.
Based on record review and staff interview, the facility failed to ensure that each direct care staff maintain current certification CPR from one of the recognized organizations. Evidence: 1. The first aid certification of Staff 1 was through the National CPR Foundation which is not one of the recognized organizations identified in the standard. 2. Staff 3 confirmed Staff 1's first aid certification was not one of the recognized organizations identified in the standard. 3. Photo evidence obtained.
Type of Inspection: Monitoring Inspection Date of Inspection: May 2 2024 -9am 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: 7 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: 0 Number of interviews conducted with staff: 1 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 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. Staff 4 confirmed that they review with resident and family, but they do not have documentation for it.
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. 2. Staff 3 stated that all the homes have the same first aid kit with missing items and will have the other items added.
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. LI showed standard and missing items on plan. Staff 3 confirmed that the listed provisions are missing on the plan.
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. 2. Staff 3 confirmed that facility has not been checking first aid kit monthly.
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. None of the emergency contact numbers were posted by the phone. 2. Staff 3 confirmed that she knew that they are to be posted and will make sure that is completed.
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. LI showed Staff 3 a copy of VDSS Resident Rights for reference from online forms and staff 3 confirmed she didn?t know to list or post the contacts.
22VAC40-73-950-F 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 3 confirmed that the facility does not have any documentation of any emergency preparedness plan review for staff or residents.
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 3 confirmed they have not been completing this notification to residents or family.
Based on record review and staff interview, facility failed to ensure that fall risk ratings are completed annually. Evidence: 1. Resident 1 last fall risk rating was dated 3/02/2023. 2. Staff 3 stated that she did not know an annual fall risk was required in Virginia and will get them updated.
Type of inspection: Renewal An unannounced renewal inspection was conducted on 11/11/2022. At the time of entrance eight 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 no violations 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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