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Source: VA State Licensing Agency
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: 09/29/2025, 12:40 p.m. to 1:40 p.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 (08/26/2025) regarding allegations in the area(s) of: Resident Care and Related Services. 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: 1 Number of staff records reviewed: 1 Number of interviews conducted with residents: 0 Number of interviews conducted with staff: 1 Observations by licensing inspector: Activities and lunch Additional Comments/Discussion: none. An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation did not support the allegation(s) of non compliance with standard(s) or law. However, violation(s) not related to the complaint(s) 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 Jacquelyn Kabiri, Licensing Inspector at (703) 397-3017or by email at Jacquelyn.Kabiri@dss.virginia.gov
Based on direct observation and staff interview, the facility failed to ensure that a medicine cabinet, container, or compartment shall be used for storage of medications, medication supplies, or dietary supplements. The storage area shall be locked. Evidence: 1. On 09/29/2025, at approximately 12:43 P.M., the Licensing Inspector (LI) observed a box labeled with resident 2?s name lying on the kitchen table. The box contained an Ascensia diabetic glucose monitoring machine. 2. Staff 1 acknowledged the box containing the medical device and promptly stored it in a locked cabinet. 3. Photo evidence taken.
Type of inspection: ?Monitoring? Date of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 09/29/2025, 1:40 P.M. to 2:40 P.M. 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 08/13/2025, regarding allegations in the area(s) of: Administration and Administrative Services. 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: 1 Number of staff records reviewed:0 Number of interviews conducted with residents:0 Number of interviews conducted with staff: 1 Observations by licensing inspector: Activities and lunch Additional Comments/Discussion: None An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation supported the self-report of non-compliance with standard(s) or law, and violation(s) were issued. Any violation(s) not related to the self-report 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 Jacquelyn Kabiri, Licensing Inspector at (703) 397-3017 or by email at Jacquelyn.Kabiri@dss.virginia.gov
Based on facility incident report and staff interview, the facility failed to submit a written report of each incident specified in 22VAC40-73-70-A to the regional licensing office within seven days from the date of the incident and shall be signed and dated by the administrator and include a description of the incident, the circumstances under which it happened, and, when applicable, extent of injury or damage. Evidence: 1. Staff 1 submitted an incident report on 08/13/2025, stating that resident 1 was transported to the hospital for care. 2. On 09/29/2025, during an onsite inspection, the Licensing Inspector (LI) asked staff 1 about resident 1?s status. Staff 1 disclosed that resident 1 had died at the hospital on 08/18/2025. However, the LI only received the initial incident report dated 08/13/2025, with no follow-up report submitted within seven days to disclose the resident?s death. 3. Resident 1?s records confirm their death at the hospital on 08/18/2025.
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: 08/13/2025, 10:00 a.m. to 1:15 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: 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: 2 Number of interviews conducted with residents: 0 Number of interviews conducted with staff: 2 Observations by licensing inspector: Lunch and activities Additional Comments/Discussion: none An exit meeting will be conducted to review the inspection findings. The evidence gathered during the inspection determined non-compliance with applicable standard(s) or law, and violation(s) were documented on the violation notice issued to the facility. The licensee has the opportunity to submit a plan of correction to indicate how the cited violation(s) will be addressed in order to return the facility to compliance and maintain future compliance with applicable standard(s) or law. If the licensee wishes to provide a plan of correction: (i) type the plan on a separate Word document, (ii) identify the standard violation number being addressed, (iii) include the date the violation will be corrected, (IV) do not include any names or confidential information, and (V) return to the licensing inspector by email within five (5) business days of the exit interview. Compliance with all applicable regulations and law shall be maintained and any areas of noncompliance must be corrected. Within 15 calendar days of your receipt of the inspection findings (inspection summary, violation notice, and supplemental information), you may request a review and discussion of these findings with the inspector's immediate supervisor. To make a request for review and discussion, you must contact the licensing supervisor at the regional licensing office that serves your geographical area. Regardless of whether a supervisory review has been requested, the results of the inspection will be posted to the DSS public website within 5 business days of your receipt of the Inspection Summary and/ or Violation Notice. The department's inspection findings are subject to public disclosure. Please Note: A copy of the findings of the most recent inspection are required to be posted on the premises of the facility. For more information about the VDSS Licensing Programs, please visit: www.dss.virginia.gov Should you have any questions, please contact Jacquelyn Kabiri, Licensing Inspector at (703) 397-3017 or by email at Jacquelyn.Kabiri@dss.virginia.gov
Based on record review and interview, the facility failed to ensure that for each resident with an inability to use the signaling device, in addition to any other services, once the resident has gone to bed each evening until the resident has arisen each morning, at a minimum, direct care staff make rounds no less often than every two hours, except that rounds may be made on a different frequency if requested by the resident and agreed to by the facility. Evidence: 1. Resident 3 had an Individualized Service Plan ( ISP
Type of inspection: Renewal Date of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 08/20/2024 and 08/21/2024, 9:30am-2:45pm and 9:30 am-5:44pm. 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: 7 Number of staff records reviewed: 3 Number of interviews conducted with residents: 1 Number of interviews conducted with staff: 3 Observations by licensing inspector: Breakfast, lunch, activities. 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 Jacquelyn Kabiri, Licensing Inspector at 703-397-3017, or by email at Jacquelyn.Kabiri@dss.virginia.gov
Based on direct observation and audit of the medication cabinet, the facility failed to follow its Infection control policy. Evidence: 1. The facility's infection control policy states that all contaminated sharps shall be discarded as soon as feasible in sharps containers located close to the point of use as feasible in each work area. 2. LI observed three used syringes in cabinet drawer three, in the medication cabinet not in a sharps container. 3. Photos taken as evidence.
Based on direct observation, review of facility documentation, and staff interview, the facility failed to maintain a written work schedule that includes the names and job classifications of all staff working each shift with an indication of whomever is in charge at any given time. Evidence: 1. The facility submitted a staff information sheet with each staff member's name. 2. The name of staff 2 is listed on a white standard-sized paper 8x11.5, posted on the whiteboard area, with the heading "Manager on Duty" but no schedule, date, or time listed. 3. The name of staff 3 is listed on a white standard-sized paper 8x11.5, posted on the whiteboard area, with the heading "Manager on Duty" but no schedule, date, or time listed. 4. Staff 1 confirmed on 08/21/2024, the facility does not have a written shift schedule listing name, position, date, time, and hours working.
Based on staff interview, the facility failed to ensure that documentation of staff rounds was completed that included the name of the resident, date and time of rounds, and the staff member who made the rounds for residents who were unable to use the signaling device. Evidence: 1. During interviews with Staff 1 and 2, with LI on 08/21/2024, along with review of Residents records, Residents 1 and 2 were not able to use a call bell signaling device. 2. The facility does not have a rounding log to document Resident monitoring. 3. Staff 1 and Staff 2 confirm there is no rounding log in use.
Based on observation of facility postings, the facility failed to post a listing of all staff who have current certification in first aid or CPR so that the information is readily available to all staff at all times. Evidence: 1. The facility did not have a list posted of staff certified in first aid/CPR. 2. On 08/21/2024, staff 1 and staff 2 acknowledged a listing of all staff who have current certification in first aid or CPR is not posted in the facility.
Based on observation, the facility failed to ensure that the interior and exterior of the building was maintained in good repair and kept clean and free of rubbish. Evidence: 1. The carpet in Resident 6's bedroom was stained and had a dingy appearance. 2. The exterior front handrail post cover was broken with sharp corners. 3. Photos taken as evidence.
Based on staff interview, the facility failed to ensure an annual review of information on the sex offender registry, including how to obtain such information and to ensure that written acknowledgment of having been so informed was provided to the resident or his legal representative and shall be maintained in the resident's record. Evidence: 1. LI (Licensing Inspector) requested documentation for Resident 1,2,3,4,5,6, and 7 of resident acknowledgment of receipt. 2. Staff 1 acknowledged during an interview with the LI (Licensing inspector) that the annual review and documentation of informing residents of the sex offender registry was not completed to meet the (VDSS) Virginia Department of Social Service standards and was not on file for any of the requested records.
Based on record reviewed and staff interviewed, the facility failed to ensure staff attend at least 4 hours of annual training on topics related to resident mental impairments. Evidence: 1. Upon record review Residents 3, 4, and 5 have a mental health diagnosis. 2. Staff record reviewed, Staff 2 date of hire 11/12/2008, and Staff 4 date of hire 07/19/2021, do not have four hours of specific training in mental health annually. 3. Staff 1 confirmed during an interview on 08/21/2024, that Staff trainings were not specific to 4 hours in mental health annually. annually.
Based on staff record review and staff interview, the facility failed to ensure that a criminal history record report was obtained on or prior to the 30th day of employment for each employee. Evidence: 1. The record for staff 3, date of hire 06/21/2024, did not contain documentation that a criminal history record report was obtained within the first 30 days of employment. 2. Hire date as 01/31/2006, however, staff 3 left and returned to work on 06/21/2024. 3. Was last conducted on 10/17/2017. 4. The record dated 10/17/2017 was in the staff file. 5. Staff 3 left employment on 09/19/2023 for personal reasons and returned on 06/21/2024.
Based on record review, observations and interviews, the facility failed to ensure residents are encouraged and informed of appropriate means as necessary to exercise his rights as a Resident and a citizen throughout the period of his stay at the facility. Evidence: 1. LI observed on 08/21/2024, interactions between staff 4, staff 5, and Resident 1. 2. Resident 1 repeatedly asked to have cigarettes to smoke. 3. Staff 4 and Staff 5 told Resident 1 they can only have 3 cigarettes a day. 4. LI interviewed Staff 2, Staff 4, and Staff 5, regarding the Resident's request and their remarks to the Resident on their daily cigarette limit. 5. Staff 2, 4, and 5, claimed the spouse of Resident 1, put the daily limit to 3 cigarettes a day. 6. Resident 1's records did not indicate on ISP
Based on observation of the facility's medication storage cabinets and document review, the facility failed to implement their medication management plan. Evidence: 1. The facility's medication management plan is to have the medication technician on duty to check medications daily to remove any outdated, damaged, or contaminated medications. 2. The facility's medication storage cabinets contained the following expired medications: a. Resident 7's Albuterol 0.5-2.5 vials for nebulizer, expired 07/28/2024. b. Leader Antacid liquid, 12fl oz, expired 7/2024 (Bottle has no label with Resident's name). c. Mylanta max strength antacid 12 fl oz, expired 08/2018, (Bottle has no label with Resident's name). 3. Resident 7 was no longer in the facility since 2023, however, their medication remained in the medication cabinet. 4. Photos taken as evidence.
Based on the medication cabinet audit, the facility failed to store schedule II drugs and any other drugs subject to abuse in a separate locked storage compartment, e.g., a locked cabinet within a locked storage area or a locked container within the cabinet. Evidence: 1. Resident 4's prescription for Lorazepam,2mg, was not locked in a container within the medication cabinet. 2. The prescription is noted to be a drug subject to abuse. 3. Photos taken as evidence.
Based on the audit of the medication cabinet, the facility failed to ensure single-use and dedicated medical supplies and equipment shall be appropriately labeled and stored. Evidence: 1. One plastic bag containing four syringes with no prescription label. 2. Photos taken as evidence.
Based on document review, resident record review, and staff interview, the facility failed to ensure a method of written communication shall be utilized as a means of keeping direct care staff on all shifts informed of significant happenings or problems experienced by residents, including complaints and incidents or injuries related to physical or mental conditions. Evidence: 1. LI requested to view the staff communication log for the facility. 2. Staff 1 and staff 2 confirmed during an interview with LI on 08/21/2024, that the facility does not use a written communication log for staff but verbally communicates information.
Date of inspection: 06/17/2024, 08:45-11:00. Type of inspection: Monitoring 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: 1. Observations by licensing inspector: Meals, Activities, Medication Pass 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 Jacquelyn Kabiri, Licensing Inspector at (703) 397-3017 or by email at Jacquelyn.kabiri@dss.virginia.gov
Based on direct observation and staff interview, the facility failed to ensure that the building interior and exterior was maintained in good repair and kept clean and free of rubbish. Evidence: 1. During the facility tour, there were 2 large rips and tears in the carpet of the second floor hallway. Staff 3 stated that the maintenance team was working on repairs but was unable to provide an invoice or completion date. 2. Staff 4 acknowledged the observed torn carpet and agreed repairs were needed.
Based on record review and staff interview, the facility failed to have a written agreement between the assisted living facility and any hospice program that provided care in the facility. Evidence: 1. Resident 3 entered hospice care on 10/17/2023. The care was provided by Hospice Agency 1. 2. No hospice agreement was found in facility files or staff files.
Date of Inspection: May 30, 2023 Type of Inspection: Monitoring Inspection If you have any questions or email changes, please do not hesitate to contact me at laura.lunceford@dss.virginia.gov. If you need a copy of any of the DSS Model forms or to review any inspection or regulation, you can find the information on the internet: www.dss.virginia.gov. Census 8 Number of records reviewed and interviews conducted- 4 records (staff and residents), 5 interviews. All facility self-reported incidents since the last inspection were reviewed on this date. The Licensing Inspector observed the residents in the common areas and individual rooms. The Licensing Inspector reviewed the following at the time of inspection: incident reports, fire drills, health care oversight and the dietician report.
An unannounced monitoring inspection was conducted on 6/7/2022 and completed on 6/7/22. At the time of entrance eight residents were in care. The sample size consisted of three resident records and three staff records. Resident and staff records and other documentation were reviewed. Virginia State Police background checks reviewed for all new staff hired since the previous inspection. Residents were observed eating breakfast. Medication administration was reviewed. An exit meeting was conducted to review the inspection findings. The evidence gathered during the inspection determined no violations with applicable standard(s) or law. The inspection summary will be posted to the VDSS website within five (5) business days of your receipt of the inspection summary. The department's inspection findings are subject to public disclosure. Please Note: A copy of the findings of the most recent inspection are required to be posted on the premises of the facility For more information about the VDSS Licensing Programs, please visit: www.dss.virginia.gov Should you have any questions, please contact Tammy Pruitt, Licensing Inspector at (703) 314-0604 or by email at tammy.pruitt@dss.virginia.gov
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 renewal inspection was initiated on 5/28/2021 and concluded on 5/28/2021. The administrator was contacted by telephone for an entrance interview 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 inspection. The inspector reviewed two resident records and two staff records. Criminal record checks and sworn statements of all staff hired since last inspection and other documentation submitted by the facility was reviewed to ensure documentation was complete. Exit interview was conducted with the administrator on 6/01/2021. The information gathered during the inspection determined no violations with applicable standards or law. No violations were issued. Thank you for your cooperation and if you have any questions please call (703) 895-5627 or contact me via e-mail at jeannette.zaykowski@dss.virginia.gov.
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