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Source: VA State Licensing Agency
Type of inspection: Renewal Date of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 05/19/2025 9:00 AM to 1:55 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: 2 Number of staff records reviewed: 3 Number of interviews conducted with residents: 1 Number of interviews conducted with staff: 4 Observations by licensing inspector: Meals, Activities, Medication Pass, Medication Storage Audit Additional Comments/Discussion: N/A 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 Amanda Velasco, Licensing Inspector at (703) 397-4587 or by email at Amanda.Velasco@dss.virginia.gov
Based on resident record review and staff interview, the facility failed to ensure that the disclosure statement was on a form developed by the department. Evidence: 1. Resident 3?s, admitted 05/01/2025, record contained a disclosure statement prepared on the form version number 032-05-0849-06-eng (10/19). 2. In a phone interview with the LI on 05/19/2025, Staff 1 confirmed that the form was not on the most recent version of the department developed form.
Based on direct observation, facility document review, and staff interview, the facility failed to ensure the designated direct care staff person in charge was on the premises while in charge. Evidence: 1. On 05/19/2025, the LI observed the person-in-charge posted as Staff 4. 2. In an interview with the LI, Staff 5 stated that Staff 4 was out at an appointment. 3. In a phone interview with the LI on 05/19/2025, Staff 1 acknowledged that Staff 4 was not on the premises while in charge. 4. Photo evidence obtained.
Based on direct observation and staff interview, the facility failed to ensure that all beds were placed only in bedrooms and that that staff did not share bedrooms with residents. Evidence: 1. On 05/19/2025, two licensing staff observed a bed in the family room on the basement level. 2. In an interview with the LI on 05/19/2025, Staff 5 stated that the bed in the family area was used for respite. 3. In a phone interview with the LI on 05/19/2025, Staff 1 acknowledged that there was a bed in a common area of the facility. 4. On 05/19/2025, two licensing staff observed an unlocked bedroom at the facility. 5. In an interview with the LI on 05/19/2025, Staff 5 stated that a staff member was using the room while Resident 4 was out of the facility. Staff 5 stated Staff 3 was staying in the room. 6. In an interview with the LI on 05/19/2025, Staff 3 stated that they were not sleeping in Resident 4?s room; however, they were keeping their items in Resident 4?s closet during their shift. 7. In a phone interview with the LI on 05/19/2025, Staff 1 acknowledged that Resident 4?s bedroom was being utilized by Staff 3.
Based on direct observation and staff interview, the facility failed to ensure that all cleaning supplies were stored in a locked area. Evidence: 1. On 05/19/2025, two licensing staff observed an unlocked laundry room on the basement level. Within the laundry room, there was an unlocked closet which contained two bottles of Fabuloso, 1 bottle of bleach, 1 container of powder Laundry Detergent, three cans of Febreeze, and two cans of Lysol. 2. In a phone interview with the LI on 05/19/2025, Staff 1 confirmed that the cleaning supplies were not stored in a locked area. 3. Photo evidence obtained.
Based on direct observation and staff interview, the facility failed to ensure the implementation of procedures of infection prevention measures by staff to include hand hygiene. Evidence: 1. On 05/19/2025, two licensing staff observed Staff 5 administer medication to Resident 1. The staff member was not observed washing their hands prior to, during, or after administering medications. 2. Staff 2 provided the infection control program dated 02/2007 which states ?Handwashing is to occur?during medication administration?? under the ?Procedures? for ?Staff.? 3. In a phone interview with the LI on 05/19/2025, the Staff 1 acknowledged that Staff 5 did not wash their hands prior to, during, or after administering medication.
Based on facility document review and staff interview, the facility failed to ensure that the infection control program was consistent with the Center for Disease Control (CDC) and Occupational Safety and Health Administration (OSHA) guidelines. Evidence: 1. On 05/19/2025, Staff 2 provided a copy of the infection control program. The infection control program was dated as implemented/revised on 02/2007. 2. The CDC?s ?Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings? was updated in both July of 2014 and November of 2022 per CDC.GOV. 3. The OSHA Infectious Diseases efforts were last updated and released in Spring of 2017 per OSHA.GOV. 4. In a phone interview with the LI on 05/19/2025, Staff 1 acknowledged that the infection control program is not consistent with the most recent guidance from CDC and OSHA.
Based on direct observation and staff interview, the facility failed to ensure that a copy of a pharmacy reference book, drug guide, or medication handbook for nurses that is no more than two years old was readily accessible. Evidence: 1. On 05/19/2025, Staff 2 provided a copy of the facility?s drug guide. The guide was dated 2018/2019. 2. In a phone interview with the LI on 05/19/2025, Staff 1 acknowledged that the drug guide that was readily accessible was more than two years old.
Based on direct observation and staff interview, the facility failed to ensure that the interior and exterior of all buildings were maintained in good repair and kept clean and free of rubbish. Evidence: 1. On 05/19/2025, two licensing staff observed the following during a tour of the building: a. The window lock in the dining area was detached and hanging from the windowsill. b. The signaling device disconnected from the wall and laying on the window ledge of a resident?s room above the bed. c. A whole in the wall with various scuff marks. d. Brown staining and/or ripped areas of carpet were observed on near the baseboards. e. A corner of the bathroom that contained debris including various black particles. f. The corner near the front door had dust and one dead bug. g. The lock on the basement gate had areas of a hole or exposed drywall surrounding the lock. 2. In a phone interview with the LI on 05/19/2025, Staff 1 acknowledged the areas listed above as not being maintained in good repair or kept clean. 3. Photo evidence obtained.
Based on staff interview, the facility failed to ensure that a written staffing 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 was maintained. Evidence: 1. On 05/19/2025, the LI requested a copy of the written staffing plan. Staff 2 stated that they had to call Staff 1. In a phone interview with the LI on 05/19/2025, Staff 1 confirmed that the facility did not maintain a written staffing plan.
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: 2/22/24 (8:45 AM - 11:40 AM). 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 interviews conducted with staff: 2 Observations by licensing inspector: Medication administration, activity An exit meeting was held. 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 Marshall Massenberg, Licensing Inspector at (703) 431-4247 or by email at m.massenberg@dss.virginia.gov.
An unannounced renewal inspection was conducted on 4/21/23. At the time of entrance, seven residents were in care. A meal, medication administration, and an activity were observed. Building and grounds were inspected. Records were reviewed. The sample size consisted of four resident records and three staff records. Violation was discussed and an exit meeting was held. 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. For more information about the VDSS Licensing Programs, please visit: www.dss.virginia.gov Should you have any questions, please contact Marshall Massenberg, Licensing Inspector at (703) 431-4247 or by email at m.massenberg@dss.virginia.gov
Based on record review and interview, the facility failed to ensure that there is an oversight of special diets, at least every six months, by a dietitian or nutritionist for each resident who has such a diet. Evidence: The most recent oversight of special diets, by a dietitian or nutritionist, was conducted on 9/13/22. Facility staff reported that the dietitian/nutritionist was contacted in March to complete another visit, but the visit had not taken place by the time of the inspection.
An unannounced focused monitoring inspection was conducted on 6/30/22 to follow-up on a high-risk violation that was cited on 5/11/22. The medication storage area was observed. Building and grounds were inspected. No violations were cited during the inspection. An exit meeting was held. Thank you for your cooperation and if you have any questions, contact me via e-mail at m.massenberg@dss.virginia.gov.
An unannounced renewal inspection was conducted on 5/11/22. At the time of entrance, two residents were in care. Building and grounds were inspected. An activity was observed. Medication and records were reviewed. The sample size consisted of two resident records and two staff records. Violations were discussed and an exit meeting was held. Areas of non-compliance are identified on the violation notice. Please complete the 'plan of correction' and 'date to be corrected' for each violation cited on the violation notice and return to the licensing office within 10 calendar days. Please specify how the deficient practice will be or has been corrected. Just writing the word 'corrected' is not acceptable. The 'plan of correction' must contain: 1) Steps to correct the non-compliance with the standards, 2) Measures to prevent the non-compliance from occurring again, and 3) Person responsible for implementing each step and/or monitoring any preventative measures. Thank you for your cooperation and if you have any questions, please contact me via e-mail at m.massenberg@dss.virginia.gov.
Based on observation, the facility failed to ensure that resident records are kept in a locked area. Evidence: Shortly after 9 AM, a cabinet was left unlocked and unattended. The cabinet contained resident records.
Based on observation, the facility failed to ensure that the medication storage area remains locked. Evidence: Shortly after 9 AM, a cabinet was left unlocked and unattended. The cabinet contained resident medication.
Based on record review, the facility failed to ensure that the medication administration record ( MAR
This inspection was conducted by licensing staff using an alternate remote protocol necessary due to a state of emergency health pandemic declared by the Governor of Virginia. A monitoring inspection was initiated on 5/24/21 and concluded on 5/24/21. The administrator's designee was contacted by telephone to initiate the inspection. The designee reported that the current census was zero. The inspector emailed the designee a list of items required to complete the inspection. The inspector reviewed two staff records, local fire and health inspections, and other documentation submitted by the facility to ensure documentation was complete. The information gathered during the inspection determined no violations with applicable standards or law. No violations were issued.
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