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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: 8-7-25 from 10:50 a.m.- 12:35 p.m. and 8-18-25 from 3:11 p.m.- 3:50 p.m. 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:3 Number of interviews conducted with staff: 1 Additional Comments/Discussion: The following items were also reviewed/observed during the inspection- facility documentation, facility postings, first aid kit, medication pass, medication administration records, and physician?s orders. An exit meeting was 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 Kimberly Davis, Licensing Inspector at (804) 356-3572 or by email at Kimberly.M.Davis@dss.virginia.gov
Based on an interview with Staff # 1, the facility failed to have the minimum amount of liability insurance coverage required to be maintained by an assisted living facility. Evidence: Upon request on 8-7-25, Staff # 1 confirmed the facility did not have the appropriate liability insurance coverage.
Based on a review of staff records on 8-7-25 the facility failed to ensure that each staff person shall annually 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. Evidence: The record for Staff # 1 (date of hire: 4-1-18) did not contain documentation of a TB assessment. This was confirmed by staff.
Based on a review of resident records on 8-7-25 the facility failed to ensure that it shall ascertain, prior to admission, whether a potential resident is a registered sex offender if the facility anticipates the potential resident will have a length of stay greater than three days or in fact stays longer than three days and shall document in the resident's record that this was ascertained and the date the information was obtained. Evidence: The record for Resident # 2 (admit date: 6-12-25) did not contain documentation of sex offender information. This was confirmed by staff.
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: 9-4-24 from 10:27a.m.-12:00 p.m. and 9-13-24 from 7:49 a.m.- 8:35 a.m. 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: 1 Number of interviews conducted with staff: 1 Additional Comments/Discussion: The following items were also reviewed/observed during the inspection-facility documentation, facility postings, first aid kit supplies, emergency food and water, medication pass, physician?s orders, and medication administration records ( MAR
Based on a review of staff records the facility failed to ensure that the rights and responsibilities of residents in assisted living facilities shall be reviewed annually with each resident or his legal representative or responsible individual and each staff person. Evidence of this review shall be the resident's, his legal representative's or responsible individual's, or staff person's written acknowledgment of having been so informed, which shall include the date of the review and shall be filed in the resident's or staff person's record. Evidence: The record for Staff # 2 contained a written acknowledgment of the review of the rights and responsibilities of residents in assisted living facilities last dated 8-1-23.
Based on a medication pass observation the facility failed to ensure that medications shall be administered in accordance with the physician's or other prescriber?s instructions. Evidence: During the medication pass on September 13, 2024, the licensing inspector observed that Resident # 2 was administered Bumetanide .5 mg prescribed for ?every other day? per the physician?s order. However, the medication administration record marked September 13, 2024 with an "X" as a day that the medication was not to be given. Staff # 2 confirmed this.
Based on observation the facility failed to ensure that at least one direct care staff member shall be awake and on duty at all times in each building when at least one resident is present. Evidence: There was no staff member present at the facility when the licensing inspector arrived on September 4, 2024 at 10:27 a.m. A male resident opened the door for the inspector. When asked if a staff person was present, the resident informed the inspector that there was not a staff member currently there. The licensing inspector contacted Staff # 2 via telephone at approximately 10:41 a.m. and Staff # 2 arrived at the facility within approximately five minutes.
Based on a review of resident records the facility failed to ensure that at the time the medication is administered, the facility shall document on a medication administration record ( MAR
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: 8-21-23 from 11:00 a.m.- 1:35 p.m. and 8-25-23 from 7:50 a.m.- 8:30 a.m. 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: 4 Number of staff records reviewed: 3 Number of interviews conducted with residents: 2 Number of interviews conducted with staff: 1 Additional Comments/Discussion: The following items were also reviewed/observed during the inspection: facility documentation, facility postings, first aid kit, emergency food and water. An exit meeting was 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 Kimberly Davis, Licensing Inspector at (804) 662-7578 or by email at Kimberly.M.Davis@dss.virginia.gov
Based on a review of resident and staff records the facility failed to ensure that the rights and responsibilities of residents in assisted living facilities shall be reviewed annually with each resident or his legal representative or responsible individual and each staff person. Evidence of this review shall be the resident's, his legal representative's or responsible individual's, or staff person's written acknowledgment of having been so informed, which shall include the date of the review and shall be filed in the resident's or staff person's record. Evidence: -The record for Resident # 2 (admit date: 7-20-2020) contained written acknowledgment of an annual review of resident rights last dated 1-1-22. -The record for Resident # 4 (admit date: 9-1-21) contained written acknowledgment of an annual review of resident rights last dated 1-1-22. -The record for Staff # 1 (date of hire: 3-20-18) contained written acknowledgment of an annual review of resident rights last dated 1-1-21.
Based on a review of staff records the facility failed to ensure that each direct care staff member shall maintain current certification in first aid. Evidence: The record for Staff # 2 (date of hire: 10-1-2-2020) contained first aid certification that expired 7-1-23.
Based on a review of resident records the facility failed to ensure that based upon review of the UAI
Based on a review of resident records the facility failed to ensure the resident's record shall contain the physician's or other prescriber's signed written order or a dated notation of the physician's or other prescriber's oral order. Orders shall be organized chronologically in the resident's record. Evidence: The record for Resident # 2 (med pass) did not contain signed physician?s orders.
Based on a review of staff records the facility failed to ensure that there shall be at least one staff person in each building at all times who has current certification in CPR. Evidence: The record for Staff # 2 (date of hire: 10-1-2-2020) contained CPR certification that expired 7-1-23.
Based on a review of staff records the facility failed to ensure that each staff person shall annually submit the results of a risk assessment, documenting that the individual is free of tuberculosis (TB) 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: The record for Staff #1 (date of hire: 3-20-18) contained a TB screening last dated 7-24-22.
Upon admission, the assisted living facility shall provide an orientation for new residents and their legal representatives, including emergency response procedures, mealtimes, and use of the call system. If needed, the orientation shall be modified as appropriate for residents with cognitive impairments. Acknowledgment of having received the orientation shall be signed and dated by the resident and, as appropriate, his legal representative, and such documentation shall be kept in the resident's record. Evidence: The record for Resident # 3 (admit date: 3-1-23) did not contain acknowledgment of having received the orientation.
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: 10-25-22 from 10:05 a.m.- 12:55 p.m. 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: 4 Number of staff records reviewed: 3 Additional Comments/Discussion: The following items were also reviewed/observed during the inspection: facility documentation, facility postings, first aid kit, emergency food and water supply, physician?s orders/Medication Administration Records ( MAR
Based on a review of resident records the facility failed to ensure that at the time of discharge a copy of the discharge statement shall be retained in the resident?s record. Evidence: The record for Resident # 1 (discharge date: 2-12-22) did not contain a discharge statement. The administrator stated that she forgot to complete the discharge statement.
Based on a review of facility documentation the facility failed to ensure the semi-annual review of its emergency preparedness and response plan. Evidence: The facility?s review of the emergency preparedness and response plan was dated 1-8-22. The administrator stated that she thought it was an annual review.
Based on a review of the facility?s first aid kit the facility failed to ensure that the first aid kit included all required items. Evidence: The first aid kit did not contain a thermometer. The administrator stated that she would replace the kit?s thermometer.
Based on a tour of the facility the facility failed to ensure that residents may not share bar soap. Evidence: During a tour of the facility with the administrator the licensing inspector observed bar soap on the sink in the downstairs common bathroom. (Photographic evidence was taken). The administrator stated that the bathroom is shared by four residents and she would ensure that the residents use only the liquid hand soap.
Based on a review of facility documentation the facility failed to ensure that a licensed health care professional, practicing within the scope of his profession, shall provide health care oversight at least every six months, or more often if indicated, based on his professional judgment of the seriousness of a resident?s needs or stability of a resident?s condition. Evidence: The facility?s healthcare oversight was last dated 3-1-22. The administrator stated that she would ensure that the healthcare professional was contacted to complete another healthcare oversight.
Based on a review of staff records the facility failed to ensure that the rights and responsibilities of residents in assisted living facilities were reviewed annually with each staff person and that evidence of this review shall be the staff person's written acknowledgement of having been so informed, which shall include the date of review and shall be filed in the staff person?s record. Evidence: The record for Staff # 1 (date of hire: 4-7-18), Staff # 2 (date of hire: 10-1-2020), and Staff # 3 (date of hire: 3-20-18) contained an annual review of resident rights last dated 1-1-21. The administrator stated that she will ensure all that the review of resident rights will be updated for all staff.
Based on a review of resident records the facility failed to ensure that upon admission, the assisted living facility shall provide an orientation for new residents and their legal representatives, including emergency response procedures, mealtimes, and use of the call system. If needed, the orientation shall be modified as appropriate for residents with cognitive impairments. Acknowledgment of having received the orientation shall be signed and dated by the resident and, as appropriate, his legal representative, and such documentation shall be kept in the resident?s record. Evidence: The record for Resident # 2 (admit date: 2-1-22) did not contain an acknowledgment of orientation. The administrator stated that the resident was oriented at admission but it was not documented.
Based on a review of resident records the facility failed to ensure that the resident?s record shall contain the physician?s or other prescriber?s signed written order or a dated notation of the physician?s or other prescriber?s oral order. Evidence: The record for Resident # 1 (med pass) contained a physician?s order sheet that was not signed by the physician. The administrator stated she thought the order was electronically signed.
Based on a tour of the facility the facility failed to ensure that common face/hand washing sinks shall have liquid soap for hand washing. Evidence: During a tour of the facility with the administrator the licensing inspector observed that the liquid soap dispenser in the downstairs common bathroom did not contain soap. The administrator stated that she would have the liquid soap dispenser refilled.
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: 2-24-22 from 10:24 a.m.- 11:45 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 2-14-22 regarding allegations in the area(s) of: resident care of one identified resident. Number of residents present at the facility at the beginning of the inspection: 7 Number of resident records reviewed: 1 Number of interviews conducted with staff: 2 An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation supported the allegation(s) of non-compliance with standard(s) or law, and a violation was issued. 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 Kimberly Davis, Licensing Inspector at (804) 662-7578 or by email at Kimberly.M.Davis@dss.virginia.gov
Based on complaint information received, from a medical professional, and an interview with the facility's administrator, the facility failed to ensure that services were provided to prevent clinically avoidable complications including pressure ulcer development or worsening of an ulcer. Evidence: -According to the medical professional's report, Resident #1 who was admitted to the hospital on 02-12-2022 had a "significant pressure ulcer on her sacrum that had a putrid smell" and "resident also had pressure wounds on her left breast, her left arm in the elbow area, both of her heels and on both legs in between her knees." -Staff #1 and Staff #2 stated that Resident #1 (admit date: 4-10-21) bathed, dressed, and toileted herself independently and staff was not aware of pressure ulcers on various areas of her body. Resident's UAI
A renewal inspection was initiated on August 4, 2021 and concluded on August 6, 2021. The administrator was contacted by telephone to initiate the inspection. The administrator reported that the current census was 7. The inspector emailed the administrator a list of items required to complete the remote documentation review portion of the inspection. The inspector reviewed 2 resident records, 2 staff records, physician's orders, Medication Administration Records ( MAR
Based on a tour of the facility, the facility failed to ensure that there was an availability of at least 48 hours of emergency drinking water. Evidence: There was no supply of emergency drinking water upon observation by the Licensing Inspector. The administrator stated that she had to "get more water".
Based on a tour of the facility, the facility failed to ensure that the most recently issued violation notice was posted. Evidence: The most recently issued violation notice was not posted in the facility.
Based on a tour of the facility, the facility failed to ensure that grab bars were installed by each toilet. Evidence: There was no grab bar by the toilet in the upstairs bathroom.
Based on a review of staff records, the facility failed to ensure that training is provided by a qualified individual through in-service training programs or institutes, workshops, classes, or conferences. Evidence: The record of training for Staff # 1 and Staff # 2 contained documentation of Trainer/Educator (Person, Agency, Organization) as "Google CNN" and "ABC News" for multiple trainings and did not include trainings provided by a qualified individual through in-service training programs or institutes, workshops, classes, or conferences.
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