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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: An on-site inspection of the facility was completed on October 20, 2025, as part of the renewal of licensure process. The inspection began at approximately 12:15 PM and concluded at approximately 2:30 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: 13 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: 2 Number of interviews conducted with staff: 2 Observations by licensing inspector: The residents were observed to be appropriately dressed and groomed for the weather conditions, types of activities they were engaged in, and time of day. Interactions amongst residents and with staff were appropriate. There were no evident conditions in the home or the surrounding grounds that were indicative of being kept in unsafe/unsanitary conditions. Additional Comments/Discussion: 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 Coy Stevenson, Licensing Inspector at (804) 972-4700 or by email at coy.stevenson@dss.virginia.gov.
Based on a review of documentation and interviews, the facility did not maintain documentation of monthly emergency generator tests. Evidence: 1) The facility is equipped with an emergency generator and is subject to the requirements of conducting and documenting monthly tests of the emergency generator. 2) Employee #1 confirmed during their interview that monthly tests of the emergency generator did not occur.
Based on a review of documentation and inter-views, the facility did not ensure that an annual review of infection prevention policies and procedures was completed, and any necessary updates were made. Evidence: 1) At the time of the on-site review, the facility did not have documentation showing that an annual review of the infection prevention policies and procedures occurred. 2) Employee #1 confirmed during their interview that an annual review of the infection prevention policies and procedures did not occur.
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: An on-site inspection related to a complaint was completed on October 20, 2025. 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 September 26, 2025, regarding allegations in the area(s) of: ADMISSION, RETENTION AND DISCHARGE OF RESIDENTS, RESIDENT CARE AND RELATED SERVICES, RESIDENT ACCOMMODATIONS AND RELATED PROVISIONS, and BUILDINGS AND GROUNDS 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 interviews conducted with residents: 1 Number of interviews conducted with staff: 2 Observations by licensing inspector: The resident identified in the complaint was interviewed and observed interacting with other residents and employees. The resident was appropriately dressed and groomed for the types of activities they were engaged in, the weather conditions, and time of day. Additional Comments/Discussion: The evidence gathered during the investigation did not support the allegation(s) of non-compliance with standard(s) or law. The inspection summary will be posted to the VDSS website within 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 Coy Stevenson, Licensing Inspector at (804) 972-4700 or by email at coy.stevenson@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: 11/27/24 between 10:20 AM and 11:40 AM 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: 12 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 interviews conducted with residents: 3 Number of interviews conducted with staff: 2 Observations by licensing inspector: 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 Coy Stevenson, Licensing Inspector at (804) 972-4700 or by email at coy.stevenson@dss.virginia.gov.
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: 11-29-2023, 12:50 ? 3pm 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: 12 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 Alex Poulter, Licensing Inspector at (804)662-9771 or by email at alex.poulter@dss.virginia.gov
Based on record review and interview with staff, the facility failed to ensure a person?s physical examination completed by an independent physician contained the following requirements. Evidence: 1. Resident #1 admitted 9-18-2023. Resident #1?s physical examination dated 8-22-2023 was missing the resident?s telephone number, blood pressure, a description of of the person?s reaction to shellfish, and a statement that specifies whether the individual is or is not capable of self- administering medication. 2. Staff #1 acknowledged during interview that the physical did not contain the required information.
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: 9-21-2022, 8 ? 10:30 am and 2:45 ? 3:15 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: 14 Number of resident records reviewed: 6 Number of staff records reviewed: 4 Number of interviews conducted with staff: 3 Observations by licensing inspector: Meal, Medication Administration, Tour, Water Temperatures, Emergency Food and Water, Records 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 Poulter, Licensing Inspector at (804)662-9771 or by email at alex.poulter@dss.virginia.gov
Based on record review, the facility failed to ensure the comprehensive individualized service plan ( ISP
Based on observation and interview with staff, the facility failed to ensure hot water at taps available to residents was maintained within a range of 105?F to 120?F. Evidence: 1. During tour of the facility, the following two temperatures were obtained at two taps available to residents: A. Downstairs shared bathroom ? 125.5?F; B. Upstairs shared bathroom ? 129?F. 2. Staff #1 was present during the tour and observed the water temperatures not within the required range.
Based on record review and interview with staff, the facility failed to ensure within the 30 days preceding admission, a person shall have a physical examination by an independent physician. The report of such examination shall be on file at the assisted living facility. Evidence: 1. The following resident records did not contain a physical examination within 30 days preceding admission and instead had physical examinations with the following dates: A. Resident #3: Admitted 12-27-2021; examination on 8-24-2022; and B. Resident #6: Admitted 12-27-2021; examination on 5-11-2021. 2. Staff #1 confirmed during interview that the aforementioned physical examinations in the record were not within 30 days preceding admission. Staff #1 and Staff #4 stated that they have been purging the initial admission physical examination and not keeping them in the residents? records.
Based on record review and interview with staff, 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 evidence of this review shall be the resident's, his legal representative's responsible individual's, which shall include the date of the review and shall be filed in the resident's or staff person's record. Evidence: 1. Resident #1 admitted 4-10-2017. Resident #1?s most current annual rights was signed 1-01-2021. 2. Staff #4 acknowledged the most current annual rights for Resident #1 were not completed.
Based on record review and interview with staff, the facility failed to ensure individualized service plans ( ISP
Based on record review and interview with staff, the facility failed to ensure the resident's record contained 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: 1. The following medications were administered to the residents on the date of inspection without a copy of the signed written order for the medications: A. Resident #1: Lithium Carb 300 mg, B. Resident #3: Metformin 500 mg, and C. Resident #7: Mirtazapine 30 mg. 2. Staff #2 confirmed the signed physician?s orders for the aforementioned residents? medications were not at the facility.
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