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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: 02/03/2026 9am -12:45pm 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: 2 Observations by licensing inspector: LI observed the residents in the common area watching TV and medication administration. Additional Comments/Discussion: 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. 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 Alexandra Roberts, Licensing Inspector at (804) 845-6956 or by email at Alexandra.n.roberts@dss.virginia.gov
Based on record review and interview, the facility failed to ensure that the comprehensive individualized service plan ( ISP
Based on record review and interview, the facility failed to ensure that a semi-annual review on the emergency preparedness and response plan for all staff, residents, and volunteers, with emphasis placed on an individual's respective responsibilities. The review shall be documented by signing and dating. Evidence: 1. LI requested the semi-annual review on emergency preparedness and response plan for all residents. 2. Staff 3 confirmed that facility has not completed a semi-annual review with all residents.
Based on observation and interview, the facility failed to ensure that the interior and exterior of all buildings shall be maintained in good repair. Evidence: 1. During inspection on 02/03/2026, LI observed in the common area sunroom that a portion of the wooden window seal appeared to be decomposed and falling off one window. 2. A separate window in the same room, the wooden window seal/molding had detached and split from the windowpane. 3. One window in the same room was unable to be closed completely evident by a small opening in the bottom left. The window was tied semi-shut with a white electrical wire that was looped into 2 circular hooks drilled on to the window frame. 4. Staff 3 acknowledged the interior windows not being in good repair. 5. Photo evidence obtained.
Based on observation and interview, the facility failed to ensure that grounds shall be properly maintained to include removal of snow and ice. Evidence: 1. During inspection on 02/03/2026, LI observed snow and ice on the back patio deck attached to the common room, side kitchen door and a lower-level exit door that are all accessible by residents. 2. Staff 3 confirmed that the snow from those areas had not been removed. 3. Photo evidence obtained.
Based on observation, interview and record review, the facility failed to ensure a method for verifying that medication orders have been accurately transcribed to medication administration records ( 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: 1/28/2025 9am - 4pm 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: 3 Number of staff records reviewed: 3 Number of interviews conducted with residents: 1 Number of interviews conducted with staff: 3 Observations by licensing inspector: LI observed residents eating breakfast and lunch. LI also observed a medication pass during the day. Additional Comments/Discussion: 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 observation and interview, facility failed to ensure that the telephone numbers for the fire department, rescue squad or ambulance, police, and Poison Control Center shall be posted by each telephone shown on the fire and emergency evacuation plan. Evidence: 1. LI observed 3 telephones in the kitchen, living room and bathroom with none of the required telephone numbers posted. 2. Staff 1 stated that they thought the numbers were posted. 3. Photo evidence obtained.
Based on record review and staff interview, facility failed to ensure that a listing of all staff who have current certification in first aid or CPR, in conformance with subsections A and B of this section, shall be posted in the facility so that the information is readily available to all staff at all times. Evidence: 1. LI requested listing of all staff with CPR or first aid. 2. Staff 1 provided the ?staff schedule? document included the on-duty employees names with checkmarks of the staff credentials. 3. Staff 1 & Staff 2 both confirmed there is no list that is posted with all staff and their associated certifications. 4. Photo evidence obtained.
Based on observation and staff interview, facility failed to ensure that the fire and emergency evacuation drawing shall show primary and secondary escape routes, areas of refuge, assembly areas, telephones, fire alarm boxes, and fire extinguishers, as appropriate. Evidence: 1. LI observed evacuation drawing posted by front door entrance missing secondary escape routes, area of refuge, telephones and fire alarm boxes. 2. Staff 1 confirmed that the posted illustration is the only available evacuation drawing.
Based on record review, facility failed to ensure that physician or other prescriber orders, both written and oral, for administration of all prescription and over-the-counter medications and dietary supplements shall identify the diagnosis, condition, or specific indications for administering each drug. Evidence: 1. Resident 1?s (Admitted: 10/25/2024) physician orders (18 medications total) signed on 10/31/2024 failed to include the diagnosis, condition, or specific indications for administering each drug. 2. Photo evidence obtained.
Based on record review and staff interview, facility failed to ensure an annual review of the infection prevention policies and procedures for any necessary updates. A licensed health care professional, practicing within the scope of his profession and with training in infection prevention, shall be included in the review to ensure compliance with applicable guidelines and regulations. Documentation of the review shall be maintained at the facility. Evidence: 1. LI requested infection prevention annual review documentation. Staff 1 provided infection control plan dated 1/23/2018 that included the annual review documentation log. The log had no current or past reviews noted. 2. Staff 1 confirmed an annual review with all required parties has not been completed. 3. Photo evidence obtained.
Based on observation and staff interview, facility failed to ensure that Medication Administration Records ( MAR
Based on observation and record review, facility failed to ensure that no medication or treatment shall be started, changed, or discontinued by the facility without a valid order from a physician or other prescriber. Evidence: 1. LI observed Staff 2 crush Lorazepam 0.5mg, mix into apple sauce and administer to Resident 1 (Admitted: 10/25/2024) - LI requested orders for medication and the orders for the medication to be crushed and further added into apple sauce. 2. Staff 1 provided ?ambulatory visit summary? dated 1/7/2025 visit & printed on 1/9/2025 in Resident 1?s record indicating medication changes for: - D/C ?current quetiapine orders? ? Start Quetiapine 75mg at 7pm. - D/C ?current Lorazepam orders? ---Start Lorazepam 0.5mg at noon - ?Begin Clonazepam 0.5mg daily at 7pm. Hold for Sedation? - ?Ambulatory visit summary? did not have any physician signatures. 3. Staff 1 further provided a different provider letter dated 1/16/2025 with ?Crushable/opened?? followed by ?yes?. No physician signature was on the document. 4. Resident 1?s record contained physician orders (18 medications total) signed on 10/31/2024 and did not reflect the changes made on 1/7/2025 or the additional changes made on 1/16/2024. 5. LI did not observe valid orders during the inspection. Staff 1 informed they believed the visit summary and letter were physician orders.
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: 1/12/24 (8:45 AM - 12:30 PM). 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: Meal, 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.
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: 8/28/23 (7:50 AM - 8:45 AM). An unannounced focused monitoring inspection was conducted on 8/28/23 to follow-up on a high-risk violation that was cited on 4/4/23. Medication administration and resident records were observed. 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 focused monitoring inspection was conducted on 4/4/23 (7:50 AM - 9:45 AM) to follow-up on a high-risk violation that was cited on 2/9/23 and a facility reported incident. Medication administration and resident records were observed. 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 observation and record review, the facility failed to ensure that medications are administered in accordance with the physician's instructions and consistent with the standards of practice outlined in the current medication aide curriculum approved by the Virginia Board of Nursing. Evidence: Resident #1's morning medication administration was observed during the inspection. Resident #1's Levothyroxine was administered while the resident was eating breakfast. Resident #1's Levothyroxine bottle states that the medication should be given on an empty stomach.
An unannounced focused monitoring inspection was conducted on 2/9/23, to follow-up on high-risk violations that were cited on 11/16/22. Medication administration was observed, physician's orders were reviewed, and building and grounds were inspected. Violations were discussed and an exit meeting was held. 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 observation and record review, the facility failed to ensure that medications are administered in accordance with the physician's or other prescriber's instructions and consistent with the standards of practice outlined in the current registered medication aide curriculum approved by the Virginia Board of Nursing. Evidence: Resident #1 was administered one 500mg tablet of Acetaminophen, during the observed medication pass. Resident #1's medication administration record ( MAR
Based on observation, the facility failed to ensure that cleaning supplies and other hazardous materials are stored in a locked area. Evidence: Liquid bleach was observed to be unlocked and unattended on the kitchen counter. Disinfectant spray was observed to be unlocked and unattended in a cabinet, under the kitchen sink.
An unannounced renewal inspection was conducted on 11/16/22 (8:00 AM ? noon). At the time of entrance, eight residents were in care. Meals, medication administration, and an activity were observed. Building and grounds were inspected. Facility documents and records were reviewed. The sample size consisted of four resident records and three staff records. Violations were discussed and an exit meeting was held. 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 observation and documentation, the facility failed to limit medication storage to an out-of-sight place in the rooms of residents whose UAI
Based on observation and documentation, the facility failed to ensure that each diet prescribed by a physician is prepared and served according to the physician?s or other prescriber?s orders. Evidence Resident #2 was observed eating cold cereal with milk. Resident #2?s physical, dated 7/25/22, states that she needs a mechanical soft diet.
Based on observation, the facility failed to implement a procedure for posting the name of the current on-site person in charge. Evidence: Upon the licensing inspector?s arrival at the facility, Staff #1 was listed as the manager on duty. Staff #1 was not present at the facility, when the inspection began.
Based on observation and record review, the facility failed to ensure that medications are administered in accordance with the physician?s instructions and consistent with the standards of practice outlined in the current medication aide curriculum approved by the Virginia Board of Nursing. Evidence: Medication administration was observed for Resident #3 during the inspection. Resident #3?s record contained an order (dated 8/26/22) for the resident to receive Acetaminophen twice per day. Resident #3?s Acetaminophen was not administered during the initial medication pass and that order was not included in Resident #3?s November medication administration record ( MAR
An unannounced inspection was conducted on 3/2/22, in response to a complaint that was received by the licensing office on 2/24/22. One resident record was reviewed. The allegations were determined to be valid, as a preponderance of evidence supported the allegations. The 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, contact me via e-mail at m.massenberg@dss.virginia.gov.
Based on record review, the facility failed to ensure that individualized service plans are reviewed and updated for a significant change of a resident's condition. Evidence: Resident #1 was admitted to the facility on 1/7/22. Resident #1's uniform assessment instrument ( UAI
Based on record review, the facility failed to ensure that services are provided to prevent clinically avoidable complications, including: Pressure ulcer development or worsening of an ulcer. Evidence: Resident #1's record was reviewed during the inspection. A hospice note, dated 1/27/22, states that Resident #1 has a stage 1 ulcer to his coccyx. The record also contains an order, dated 1/28/22, that calls for Calmoseptine to be applied topically to the coccyx area, every time incontinence care is provided. A hospice note, dated 1/28/22, states that ALF staff are aware to turn reposition Resident #1 every two hours. Resident #1's ISP
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