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Source: VA State Licensing Agency
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: An annual on-site monitoring inspection of the facility was completed on February 03, 2026. 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: 2 Number of interviews conducted with residents: 4 Number of interviews conducted with staff: 3 Observations by licensing inspector: The residents were noted to be appropriately dressed and groomed for the time of day, weather conditions, and activities they were engaged in. interactions amongst residents and with staff were professional and appropriate. There were no health or safety concerns identified. Additional Comments/Discussion: 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. Your plan of correction must contain: 1) steps to correct the noncompliance with the standard(s), 2) measures to prevent the noncompliance from occurring again; and 3) person(s) responsible for implementing each step and/or monitoring any preventive measure(s). 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 these 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. Refer to General Procedures and Information for Licensure, 22VAC40-80-260-B for information on requesting a problem solving conference. 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 Coy Stevenson, Licensing Inspector at (804) 972-4700 or by email at coy.stevenson@dss.virginia.gov
Based on record reviews and interviews, it was determined that the provider did not ensure that the date of employment for staff was maintained in the respective record for each staff person. Evidence: 1) A review of the record for staff #1 did not include the date of hire 2) The record for staff #1 contained an application for employment that was dated September 03, 2024. 3) During the interview with staff #3 , they stated that staff #1 was initially scheduled to be hired in September 2024, but they were actually hired in October 2025.
Based on record reviews and interviews, it was determined that the facility did not ensure that all newly hired staff were provided with orientation and training on the topics required by 22VAC40-73-120.B and 22VAC40-73-120.C within the first seven working days of employment. Evidence: 1) At the time of the on-site review, a review of the record for staff #1 did not contain documentation showing they were trained on the topics required by 22VAC40-73-120.B and 22VAC40-73-120.C 2) Staff #3 confirmed documentation showing staff #1 was trained on the topics required by 22VAC40-73-120.B and 22VAC40-73-120.C was missing from the record for staff #1.
Based on record reviews and interviews, it was determined that the provider did not ensure that documentation showing the absence 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, was completed for each staff person, on or within seven days prior to the first day of work at the facility. Evidence: 1) A review of the record for staff #1 did not include the date of hire 2) The record for staff #1 contained an application for employment that was dated September 03, 2024. 3) During the interview with staff #3, they stated that staff #1 was initially scheduled to be hired in September 2024, but they were actually hired in October 2025. 4) A review of the record for staff #1 included documentation showing the absence of tuberculosis in a communicable form dated April 04, 2025. Because this documentation showing the absence of tuberculosis in a communicable form was completed six months before they were hired, an updated screening needed to be completed no more than seven days of staff #1 being hired and coming into contact with residents.
Based on record reviews and interviews, it was determined that the provider could not demonstrate they are in compliance with the Virginia Statewide Fire Prevention Code (13VAC5-51). Compliance is determined by at least an annual inspection by the appropriate fire official. Evidence: 1) During the interview with staff # , they stated that an annual inspection by the appropriate fire official has not been completed. 2) The most recent inspection by the appropriate fire official was completed on September 03, 2024.
Type of inspection: Complaint Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: July 01, 2025 from approximately 9:30 AM ? 10:30 AM. The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. A complaint was received by VDSS Division of Licensing on May 20, 2025, regarding allegations in the area(s) of: PERSONNEL and STAFFING AND SUPERVISION The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of interviews conducted with residents: 2 Number of interviews conducted with staff: 2 Observations by licensing inspector: All the residents were appropriately dressed and groomed for the time of day and the activities they were engaged in. There were an appropriate number of staff on-duty to meet the needs of the residents. Additional Comments/Discussion: The evidence gathered during the investigation did not support the allegation(s) of non-compliance with standard(s) or law. The inspection summary will be posted to the VDSS website within 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 Coy Stevenson, Licensing Inspector at (804) 972-4700 or by email at coy.stevenson@dss.virginia.gov.
Type of inspection: Complaint Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: The licensing inspector was on-site from approximately 9:30 AM ? 10:30 AM A complaint was received by VDSS Division of Licensing on January 23, 2025, regarding allegations in the area(s) of: staff qualifications, resident rights, medication administration 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: 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: Number of interviews conducted with residents: Number of interviews conducted with staff: 2 Observations by licensing inspector: Additional Comments/Discussion: Residents were observed moving freely around the interior and exterior of the home. Resident interactions amongst themselves and staff were appropriate. Residents were appropriately dressed and groomed for the time of day, weather conditions, and activities engaging in. An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation did not support the (allegation(s)/self-report) of non-compliance with standard(s) or law. The inspection summary will be posted to the VDSS website within 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 Coy Stevenson, Licensing Inspector at (804) 972 ? 4700 or by email at coy.stevenson@dss.virginia.gov.
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: The inspection began at approximately 11:30 AM and was concluded at approximately 3:45 PM 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: 2 Number of interviews conducted with staff: 2 Observations by licensing inspector: Additional Comments/Discussion: Residents were observed moving freely around the interior and exterior of the home. Resident interactions amongst themselves and staff were noted as appropriate. Staff effectively redirected residents when needed. The residents were appropriately dressed and groomed for the time of day, location, and weather conditions. 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 Coy Stevenson, Licensing Inspector at (804) 972 ? 4700 or by email at tess.pittman@dss.virginia.gov.
Based on record reviews and interviews, it was determined that the facility did not ensure that residents complete a risk assessment for tuberculosis annually, as evidenced by the completion of the current screening form published by the Virginia Department of Health or a form consistent with it. 1) The record for resident #1 did not contain documentation showing resident #1 has completed a risk assessment for tuberculosis within one year since the last risk assessment. 2) The last risk assessment for tuberculosis for resident #1 was dated August 2, 2023.
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: 10-26-2023 10:23 ? 12:00 pm, 11-28-2023 12:26 ? 1:45 pm 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: 4 Number of staff records reviewed: 3 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 Alex Poulter, Licensing Inspector at (804)662-9771 or by email at alex.poulter@dss.virginia.gov
Based on observation and interview with staff, the facility failed to ensure bedrooms contained at least one mirror. Evidence: The bedroom occupied by Resident #1 on 10-26-2023 did not contain a mirror (nor an adjoining bathroom with a mirror). Staff #2 was present and observed on tour with licensing inspector.
Based on record review, the facility failed to ensure the individualized service plan ( ISP
Based on observation and interview with staff, the facility failed to ensure the fire and emergency evacuation drawing showed primary and secondary escape routes, areas of refuge, assembly areas, telephones, fire alarm boxes, and fire extinguishers, as appropriate. Evidence: The fire and emergency evacuation drawing observed on the 10-26-2023 inspection did not show any of the required areas including primary and secondary escape routes, areas of refuge, assembly areas, telephones, fire alarm boxes, and fire extinguishers, as appropriate. Staff #2 observed along with the licensing inspector.
Based on record review, the facility failed to ensure prior to or at the time of admission to an assisted living facility, certain personal and social information on a person shall be obtained. Evidence: 1. Resident #1 admitted 6-29-2023 according to Staff #1. The ?Patient Data Sheet? in Resident #1?s record did not contain the following information required: a. Last home address, and address from which resident was received, if different; b. Date of admission; c. Birthplace, if known; d. Marital status, if known; e. If there is a legal representative, copies of current legal documents that show proof of each legal representative's authority to act on behalf of the resident and that specify the scope of the representative's authority to make decisions and to perform other functions; f. Name, address, and telephone number of personal dentist, if known; g. Name, address, and telephone number of clergyman and place of worship, if applicable; Service in the armed forces, if applicable; h. Lifetime vocation, career, or primary role; Special interests and hobbies; i. Known allergies, if any; j. Information concerning advance directives, Do Not Resuscitate (DNR) Orders, or organ donation, if applicable; k. Previous mental health or intellectual disability services history, if any, and if applicable for care or services; l. Current behavioral and social functioning including strengths and problems; and m. Any substance abuse history if applicable for care or services. 2. Staff #1 confirmed during interview that the information on Resident #1 was not documented in the personal and social information.
Based on observation and interview with staff, the facility failed to ensure hot water at taps available to residents shall be maintained within a range of 105?F to 120?F. Evidence: The water temperature in the bathroom at the far back hallway to the left adjoining into a bedroom (that is occupied by two male residents) had a temperature of 128?F. Staff #2 was present and acknowledged the temperature was above the required degree range.
Based on record review and interview with staff, the facility failed to ensure each staff person was evaluated annually with 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. Evidence: Staff #1?s date of hire is 1-01-2020. Staff did not have an annual tuberculosis risk assessment from the past year. Staff #1 confirmed during interview.
Based on observation and interview with staff, the facility failed to ensure the rights and responsibilities of residents were posted conspicuously in a public place in the assisted living facility. Evidence: The rights and responsibilities of residents were not posted in the facility on the date of inspection, as they were not observed during the tour on 10-26-2023.
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: 8-23-2023, 10:20 ? 11 AM The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. A self-reported incident was received by VDSS Division of Licensing on August 13, 2023 regarding allegations in the area of: Resident Care and Related Services. Number of residents present at the facility at the beginning of the inspection: 7 An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation did not support the self-report of non-compliance with standard(s) or law. However, violation(s) not related to the self-report but identified during the course of the investigation can be found on the violation notice. 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 Alex Poulter, Licensing Inspector at (804)662-9771 or by email at alex.poulter@dss.virginia.gov
Based on record review, the facility failed to ensure that a person?s physical examination contained a description of the person?s reaction to any known allergies. Evidence: Resident #1 admitted 5-04-2023 to the facility. Resident #1?s Report of Resident Physical Examination dated 4-25-2023 documented, ?fish derived products and penicillin? as allergies; however, no allergy reactions were documented on the resident physical examination.
Based on record review and interview with staff, the facility failed to ensure methods for verifying that medication orders have been accurately transcribed to medication administration records ( MAR
Based on record review and interview with staff, the facility failed to ensure the complete resident record was retained for at least two years after the resident leaves the facility. Evidence: 1. Blood pressure logs for the resident as ordered by Resident #1?s physician were not documented in the medication records for the months of May, June, July, and August 2023. 2. Staff #1 stated that the blood pressure was taken per the order; however, the logs were kept separate from the medication administration records and that the blood pressure logs for Resident #1 were not retained.
Based on record review and interview with staff, the facility failed to ensure physician?s oral orders were reviewed and signed by a physician within 14 days. Evidence: 1. Resident #1?s orders for the following medications were not signed by the physician within 14 days or of oral order: A. Divalproex ER 500 mg ? 2 tabs PO HS B. Trazodone 100 mg ? 1 tab PO HS C. Quetiapine 300 mg ? 1 PO HS D. Risperidone 2 mg ? Take 2 tabs PO HS D/C Risperidone order E. Clonidine 0.2 mg ? 1 PO HS Hold for SBP<100 2. There was no signature within 14 days of the oral order by Resident #1?s physician?s for orders dated 5-11-2023.
Type of inspection: Complaint Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 1-04-2023, 10:20 ? 10:50 a.m. The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. A complaint was received by VDSS Division of Licensing on 11-10-2022 regarding allegations in the area of: Admission, Retention, and Discharge of Residents Number of residents present at the facility at the beginning of the inspection: 7 An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation supported the allegation of non-compliance with standard(s) or law, and violation(s) were issued. Any violation(s) not related to the complaint but identified during the course of the investigation can also be found on the violation notice. 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 Poulter, Licensing Inspector at (804) 662-9771 or by email at alex.poulter@dss.virginia.gov
Based on record review and interview, the facility failed to ensure prior to or at the time of admission to an assisted living facility, the following personal and social information on a person shall be obtained. Evidence: 1. Resident #1 admitted 10-20-2022 per the ?Regional Discharge Assistance Program Provider Agreement? from Agency #1; however, the following information was not documented in Resident?s file: a. Date of admission per facility, b. Last home address which resident was received from, c. Birthplace, d. Marital status, e. Name, address, and telephone number of all legal representatives, if any; f. If there is a legal representative, copies of current legal documents that show proof of each legal representative's authority to act on behalf of the resident and that specify the scope of the representative's authority to make decisions and to perform other functions; g. Name, address, and telephone number of next of kin, if known (two preferred); h. Name, address, and telephone number of designated contact person authorized by the resident or legal representative, if appropriate, for notification purposes, including emergency notification and notification of the need for mental health, intellectual disability, substance abuse, or behavioral disorder services - if the resident or legal representative is willing to designate an authorized contact person. There may be more than one designated contact person. The designated contact person may also be listed under another category, such as next of kin or legal representative; i. Name, address, and telephone number of the responsible individual stipulated in 22VAC40-73-550 H, if needed; j. Name, address, and telephone number of personal physician, if known; k. Name, address, and telephone number of personal dentist, if known; l. Name, address, and telephone number of clergyman and place of worship, if applicable; m. Name, address, and telephone number of local department of social services or any other agency, if applicable, and the name of the assigned case manager or caseworker; n. Service in the armed forces, if applicable; o. Lifetime vocation, career, or primary role; p. Special interests and hobbies; q. Known allergies, if any; r. Information concerning advance directives, Do Not Resuscitate (DNR) Orders, or organ donation, if applicable; s. Previous mental health or intellectual disability services history, if any, and if applicable for care or services; t. Current behavioral and social functioning including strengths and problems; and u. Any substance abuse history if applicable for care or services. 2. Staff #1 acknowledged during phone interview on 1-04-2023 following the inspection.
Based on record review and interview with staff the facility failed to ensure at the time of discharge, the assisted living facility shall provide to the resident and, as appropriate, his legal representative and designated contact person a dated statement signed by the licensee or administrator. A copy of the written statement shall be retained in the resident's record. Evidence: Resident #1?s record did not contain a discharge statement in the record despite the resident being discharged by the facility shortly after admittance in October, 2022. Staff #1 acknowledged during phone interview on 1-04-2023 following the inspection.
Based on record review and interview, the facility failed to ensure on or within seven days prior to the day of admission, a preliminary plan of care shall be developed to address the basic needs of the resident that adequately protects his health, safety, and welfare. Evidence: Resident #1 admitted around 10-20-2022, and no preliminary plan of care was in the resident?s record. Staff #1 acknowledged during phone interview on 1-04-2023 following the inspection.
Based on record review and interview with staff, the facility failed to ensure there was written acknowledgement of the receipt of the disclosure by the resident or his legal representative in the resident?s record. Evidence: Resident #1?s record did not contain a copy of the disclosure anywhere in the record.
Based on record review and interview with staff, the facility failed to ensure upon admission, the assisted living facility provided orientation for new residents. Evidence: Resident #1?s record did not contain acknowledgement of having received orientation to the facility, nor did Staff #1 acknowledge that Resident #1 received orientation to the facility including emergency response procedures, mealtimes, and use of the call system.
Based on record review and interview with staff, the facility failed to ensure no resident was admitted or retained who requires a level of care or service or type of service for which the facility is not licensed. Evidence: 1. Resident #1?s Uniform Assessment Instrument [ UAI
Based on record review and interview with staff, the facility failed to ensure that based upon review of the UAI
Based on record review and interview with staff, the facility failed to ensure at or prior to the time of admission, there shall be a written agreement/acknowledgment of notification dated and signed by the resident or applicant for admission or the appropriate legal representative, and by the licensee or administrator. Evidence: Resident #1 was at the facility in October 2022 as a resident. There was no resident agreement in Resident #1?s record. Staff #1 acknowledged during phone interview on 1-04-2023 following the inspection.
Type of inspection: Complaint Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 1-04-2023, 10:52 a.m. ? 11:15 a.m. The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. A complaint was received by VDSS Division of Licensing on 12-21-2022 regarding allegations in the area(s) of: Administration and Administrative Services; Resident Care and Related Services. Number of residents present at the facility at the beginning of the inspection: 7 Number of resident records reviewed: 2 Number of staff records reviewed: 0 Number of interviews conducted with residents: 0 Number of interviews conducted with staff: 3 Observations by licensing inspector: Records, interviews An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation supported some, but not all of the allegations; area(s) of non-compliance with standard(s) or law were: Administration and Administrative Services. A violation notice was issued; any violation(s) not related to the complaint but identified during the course of the investigation can also be found on the violation notice. 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 Poulter, Licensing Inspector at (804) 662-9771 or by email at alex.poulter@dss.virginia.gov
Based on record review and interview with staff, 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 admitted 11-17-2022 per the Resident Agreement. An ?Incident Report Form? dated 12-19-2022 documented at an incident at 8:55 p.m., ?[Resident #1] came down the hallway [Resident #1] walked briskly threw(sic) the common area walked around the table when passing [Resident #2] [Resident #1] pulled [Resident #2]?s stocking hat off and continue to jog to the hallway [Resident #2] jumped up and hit [Resident #1] in the face...? 2. Resident #1?s ?ED After Visit Summary? dated 12-20-2022 documented Resident #1 had a diagnosis of ?Closed fracture of left orbital floor, initial encounter? from the incident that occurred on 12-19-2022 as confirmed by Staff #1. 3. Additionally, an ?Incident Report Form? dated 12-31-2022 documented, ?At approximately 12:30 p.m., [Resident #1] exited [Resident #1?s] room, went into the kitchen and grabbed a metal grate from the stove. [Resident #1] use the grate to hit and destroy a laptop and attempted to hit a staff member with it. Staff got the grate away?? 4. Staff #1 conformed an incident report was not sent to the regional licensing office within 24 hours of the major incident involving Residents #1 and #2 on 12-19-2022 or 12-31-2022.
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