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Source: VA State Licensing Agency
Type of inspection: Monitoring Date of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 09/22/2025 10:00 AM to 1:08 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: 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: 0 Number of interviews conducted with staff: 4 Observations by licensing inspector: Meals, Medication Pass. Additional Comments/Discussion: No activities were observed because none were completed during the inspection. 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 direct observation, resident record review, and staff interview, the facility failed to ensure that ?No smoking ? Oxygen in use? signs were posted when oxygen therapy is provided to residents. Evidence: 1. During a tour of the facility, two LI?s observed oxygen concentrators in the room of Resident 1 and Resident 2, but both rooms did not have signs posted on the door. 2. The records of both Resident 1 and Resident 2 contained signed, active orders for oxygen therapy. 3. In an interview with two LI?s on 09/22/2025, Staff 3 confirmed that Resident 1 and Resident 2?s rooms did not contain ?No smoking ? Oxygen in use? signs. 4. Photo evidence obtained.
Based on direct observation and staff interview, the facility failed to ensure that cleaning supplies were stored in a locked area. Evidence: 1. During a tour of the facility, two LI?s observed six (6) bottles of cleaning supplies in an unlocked bathroom cabinet on the first floor across from Resident 1?s room. The cleaning products included two bottles of Febreze, a bottle of bleach, a bottle of Clorox spray, a bottle of pine-sol, and an aerosol spray. 2. In an interview with two LI?s on 09/22/2025, Staff 3 acknowledged that cleaning supplies were not stored in a locked area and confirmed that this was a bathroom used by residents. 3. Photo evidence obtained.
Based on direct observation, resident record review, and staff interview, the facility failed to ensure that there were no less than 80 square feet per person in bedrooms accommodating two or more residents. Evidence: 1. During a tour of the facility on 09/22/2025, two LI?s came across an unlabeled, unlocked resident room. Inside of the room, Staff 5 (identified later by Staff 2) was asleep. 2. In an interview with the LI on 09/22/2025, Staff 2 and Staff 4 stated that Staff 5 was asleep in Room 4, but room 4 was reserved for Resident 4 and Resident 5, a married couple that chooses to sleep together in one room, Room 3. 3. Room 3 has 156 square footage, per the calculations completed for the facility?s initial inspection on 04/01/2008 with a noted maximum capacity of 1 resident. 4. In an interview with the LI on 09/22/2025, Staff 3 confirmed both Resident 4 and Resident 5 reside in Room 3.
Based on direct observation and staff interview, the facility failed to ensure that hand-washing sinks had paper towels or an air dryer. Evidence: 1. During a tour of the facility, two LI?s observed no paper towels or air dryers in the first-floor bathroom across from Room 2. The paper towels were not replaced during the duration of the inspection (approximately three hours). 2. In an interview with two LI?s on 09/22/2025, Staff 3 acknowledged that there were no paper towels in the first-floor bathroom. 3. Photo evidence obtained.
Based on direct observation and staff interview, the facility failed to ensure that doors leading to the outside were unlocked. Evidence: 1. During a tour of the facility on 09/22/2025, two LI?s observed both the front and back doors that lead to the outside being locked. The back door remained locked for the duration of the inspection (approximately three hours). 2. In an interview with two LI?s, Staff 3 acknowledged that both doors were locked. 3. Photo evidence obtained.
Based on staff record review and staff interview, the facility failed to ensure that the designated person in charge was informed of their duties and responsibilities and documentation of such was recorded in the staff?s record. Evidence: 1. During a tour of the facility, the posted manager on duty was Staff 6. In an interview with two LI?s on 09/22/2025, Staff 1 stated that Staff 2 was the person in charge. 2. In a review of Staff 2?s records, there was no documentation for Staff 2 being informed of the responsibilities and job duties when in the role of designated person in charge. 3. In an interview with the LI on 09/22/2025, Staff 3 confirmed that Staff 2 was the person in charge and stated that they were unable to provide the designated person in charge training.
Based on direct observation and staff interview, the facility failed to ensure that toilet tissue was accessible to each commode. Evidence: 1. During a tour of the facility, two LI?s observed no toilet tissue in the first-floor bathroom across from Room 2. The toilet tissue was not replaced during the duration of the inspection (approximately three hours). 2. In an interview with two LI?s on 09/22/2025, Staff 3 acknowledged that there was no toilet paper in the bathroom on the first floor. 3. Photo evidence obtained.
Based on direct observation and staff interview, the facility failed to ensure that the written schedule included the names and job classifications of all staff working each shift with an indication of who?s in charge at any given time. Evidence: 1. During a tour of the facility, two LI?s observed the posted staff schedule for September 16th 2025 through September 30th, 2025 which did not include an indication of who?s in charge at any given time and multiple dates had blanks or quotation marks? next to the date. 2. In an interview with two LI?s on 09/22/2025, Staff 3 confirmed the schedule did not list the names for each staff working each shift or an indication of who?s in charge at any given time. 3. Photo evidence obtained.
Based on staff record review and staff interview, the facility failed to ensure that each manager had qualifications including having a high school diploma, having post-secondary education, and having one year of administrative or supervisory experience for each facility with a shared administrator. Evidence: 1. During a tour of the facility, the posted manager on duty was Staff 6. In an interview with the LI, Staff 4 stated that Staff 3 was the manager, and Staff 2 was the person in charge prior to the arrival of Staff 3 to the facility. Staff 3 and Staff 4 stated that Staff 6 was no longer employed but could not provide the last date of employment. Staff 2?s qualifications were requested to serve as person in charge, but were not provided. 2. In an email follow-up with Staff 7, Staff 7 stated that Staff 2 was the manager of the facility and provided a certificate for the online learning course hosted by Collateral Contact 1. Staff 7 did not provide documentation that Staff 2 was qualified to act as manager of a facility with a shared administrator.
Based on observation, resident record review, and staff interview, the facility failed to ensure that the agreement or acknowledgement was updated when there are changes to the information referenced or identified in the agreement. Evidence: 1. During a tour of the facility on 09/22/2025, two LI?s came across an unlabeled, unlocked resident room. Inside of the room, Staff 5 (identified later by Staff 2) was observed asleep. 2. In an interview with the LI on 09/22/2025, Staff 2 and Staff 4 stated that Staff 5 was asleep in Room 4, but Room 4 was reserved for Resident 4. Staff 2 and 4 stated that Resident 4 now resides with Resident 5 and no longer needs Room 4. 3. Upon resident record review, Resident 4 and Resident 5 have separate agreements. Both agreements are dated 09/03/2024, and state that a furnished bedroom will be provided to both Resident 4 and Resident 5. Neither agreement reflects the change to one shared bedroom.
Based on direct observation and staff interview, the facility failed to ensure that the designated person in charge was on the premises. Evidence: 1. During a tour of the facility, two LI?s observed the posted person in charge as Staff 6, with Staff 4?s schedule posted above listing the time on site for Monday?s as 8:00 AM to 12:00 PM. 2. In an interview with the LI on 09/22/2025, Staff 2 stated that Staff 6 was no longer employed, and they had contacted Staff 4 by phone to notify them the LI?s were conducting an inspection. Staff 2 confirmed that neither Staff 4 nor Staff 6 were on site. 3. Photo evidence obtained.
Based on resident record review and staff interview, the facility failed to ensure that Do Not Resuscitate (DNR) orders were valid. Evidence: 1. Resident 1?s record contains a DNR signed 10/15/2024 that was not completed does not have all the required boxes checked. 2. Resident 2?s record contains a DNR signed 09/12/2023 was not completed and that does not have all the required boxes checked. 3. In an interview with two LI?s on 09/22/2025, Staff 3 confirmed that the DNR orders were not valid due to being incomplete.
Based on observation, resident record review, and staff interview, the facility failed to ensure that the agreement or acknowledgement was updated when there are changes to the information referenced or identified in the agreement. Evidence: 1. During a tour of the facility on 09/22/2025, two LI?s came across an unlabeled, unlocked resident room. Inside of the room, Staff 5 (identified later by Staff 2) was observed asleep. 2. In an interview with the LI on 09/22/2025, Staff 2 and Staff 4 stated that Staff 5 was asleep in Room 4, but Room 4 was reserved for Resident 4. Staff 2 and 4 stated that Resident 4 now resides with Resident 5 and no longer needs Room 4. 3. Upon resident record review, Resident 4 and Resident 5 have separate agreements. Both agreements are dated 09/03/2024, and state that a furnished bedroom will be provided to both Resident 4 and Resident 5. Neither agreement reflects the change to one shared bedroom.
Based on direct observation and staff interview, the facility failed to ensure that there was at least 14 hours of scheduled activities available to residents each week for no less than one hour each day. Evidence: 1. During the inspection, two LI?s did not observe any activities conducted between staff and the residents. 2. In an interview with two LI?s on 09/22/2025, Staff 3 confirmed that no activities were completed during the inspection.
Based on direct observation and staff interview, the facility failed to ensure that the interior of the building was kept in good repair and clean. Evidence: 1. During a tour of the facility, two LI?s observed the following items in disrepair: a. Cracked door frame on the closet in the hallway outside of room 1 b. Hole in the door of the bathroom across from room 1 c. Light bulb frame falling out of the ceiling in the bathroom across from room 1 d. Hole in the carpet in room of Resident 1 e. Brown stain on the wall near the towel holder in the bathroom across from room 2 f. Wall patching covering the lower half of the wall in the bathroom of room 7 g. A missing faucet from the tub resulting in the pipe sticking out of the wall in the bathroom of room 7 h. The arms of a dining chair unscrewed and hanging at the side of the chair 2. In an interview with two LI?s on 09/22/2025, Staff 3 and 4 acknowledged the photo evidence and confirmed the interior was not kept in good repair. 3. Photo evidence obtained.
Type of inspection: Renewal Date of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 04/10/2025 9:15 AM to 1:00 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: 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: 3 Number of staff records reviewed: 2 Number of interviews conducted with residents: 0 Number of interviews conducted with staff: 4 Observations by licensing inspector: Meals, Activities, Medication Pass and 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 direct observation and staff interview, the facility failed to ensure that doors leading to the outside are not locked from the inside or secured in any manner that amounts to a lock. Evidence: 1. On 4/10/2025, the LI observed three locked doors in the facility including the front door, back door, and side door that leads to the driveway. The front door and back door had double locks including a deadbolt with a thumb turn and a sliding security bolt at the top of the door. Both doors also had a keypad to disarm the door alarms. 2. During a tour of the facility, the LI observed staff 4 unlock both locks and disarm the door alarm to let the LI go outside. When the LI returned inside, staff 4 locked the door again. 3. The LI requested a demonstration of the door locks and alarms. Staff 3 stated that the keypad did not lock the door, only armed or disarmed the door alarm. 4. In an interview with the LI, staff 1 confirmed that the doors should have been unlocked. 5. Photo evidence obtained.
Based on direct observation, and staff interview, the facility failed to ensure that the interior and exterior of all buildings was maintained in good repair. Evidence: 1. On 04/10/2025, the LI observed the following items in need of repair or replacement: a. The screen to the left of the door had multiple holes. b. The pavers/ walkway stones leading to the back patio area were broken and wobbly. c. The door to the bathroom had a hole in the door. d. A closet doorframe had multiple cracks and splinters. e. The patio furniture (outdoors) was cracked, broken, and missing pads, f. The cabinet doors in the kitchen were off the hinges. 2. In an interview with the LI on 04/10/2025, Staff 1 confirmed that maintenance was needed. 3. Photo evidence obtained.
Based on direct observation, facility document review, and staff interview, the facility failed to ensure that the menu for meals and snacks was posted and dated. Evidence: 1. On 04/20/2025, the LI observed the posted weekly menu that was dated ?April 2025?. The menu did not include snacks. 2. In an interview with the LI, Staff 1 acknowledged that the menu did not include snacks. 3. Photo evidence obtained.
Based on direct observation and staff interview, the facility failed to ensure cleaning supplies and other hazardous items were stored in a locked area. Evidence: 1. On 4/10/2025, the LI observed the bathroom on the first level with the door open. Inside the bathroom, the cabinet door was unlocked and contained various cleaning products including nine spray bottles and one-gallon sized jug. 2. In an interview with the LI on 04/10/2025, Staff 1 acknowledged that the cabinet was unlocked and contained cleaning products. 3. Photo evidence obtained.
Date of Inspection: September 5, 2023 Type of Inspection: Renewal inspection Census 7 Number of records reviewed and interviews conducted- 7 records, 3 interviews. All facility self-reported incidents since the last inspection were reviewed on this date. The Licensing Inspector observed residents participating in activity programs and listening to music. Licensing Inspector observed medication administration. If you have any questions or email changes, please do not hesitate to contact me at sarah.pearson@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.
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: LI entered the facility at 8:40 am on 5/17/2023 and exited at 10:50 am on 5/17/2023. 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: 6 Number of staff records reviewed: 3 Number of interviews conducted with residents: 1 Number of interviews conducted with staff: 1 Observations by licensing inspector: LI observed medication administration. LI observed residents eating breakfast and engaging in activities. Additional Comments/Discussion: An exit meeting will be 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 Jamie Eddy, Licensing Inspector at (703) 479-5247 or by email at jamie.eddy@dss.virginia.gov
An unannounced monitoring inspection was conducted on 6/6/2022 and completed on 6/6/22. At the time of entrance eight residents were in care. The sample size consisted of four resident records and four 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 engaging in activities. 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
A renewal inspection was initiated on 10/04/2021 and concluded on 10/05/2021. 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, required postings (staff schedule, activities, menu, resident rights, license, inspection documentation, Designated person in charge). The inspector conducted the on-site portion of the inspection on 10/05/2021. An exit interview was conducted with the Administrator on the date of the inspection where findings were reviewed and an opportunity was given for questions, as well as for providing any information or documentation which was not available during the inspection. Information gathered during the inspection determined no violations with applicable standards or law. No violations were issued.
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