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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: 10/6/2025 11:49am departure time: 3:30pm 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 10/3/2025 regarding allegations in the area(s) of: 22VAC40-73-(2) ADMINISTRATION AND ADMINISTRATIVE SERVICES 22VAC40-73-(6) RESIDENT CARE AND RELATED SERVICES 22VAC40-80-(G7) COMPLAINT INVESTIGATION Number of residents present at the facility at the beginning of the inspection: 23 Number of resident records reviewed: 1 Number of interviews conducted with staff: 1 Observations by licensing inspector: Inspector interviewed Administrator as well reviewed resident record. An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation supported the allegation(s) of non-compliance with standard(s) or law, and violation(s) were issued. Any violation(s) not related to the complaint(s) 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 Shelby Haskins, Licensing Inspector at (804) 305-4876 or by email at shelby.haskins@dss.virginia.gov.
Based on a staff interview, the facility failed to ensure that within 60 days of discharge, each resident or legal representative shall be given a final statement of account and any refunds due Evidence: 1) During the on-site inspection, staff #1 was asked if she had provided the legal representative for resident #1 with a final statement of account since resident #1?s discharge in July 2025. 2) Staff #1 confirmed that she had not provided the legal representative with a final statement of account for resident #1 as of October 2025.
Based on a staff interview, the facility failed to ensure that the resident and resident?s representative should have access to their own records. A legal representative of a resident shall be provided with access to the resident?s record or part of the record as allowed by the scope of his legal authority. Evidence: 1) Resident #1?s legal representative requested resident #1?s record by phone on August 15, 2025. 2) Resident #1?s legal representative provided the request for resident #1?s records in writing as well as legal documentation stating that he is the legal representative for resident #1 on September 15, 2025. 3) Staff #1 confirmed that facility did not provide the legal representative with the request of resident #1?s records as of October 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: 10/06/2025 arrival time: 11:49am departure time: 3:30pm 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: 23 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 staff records reviewed: 3 Number of interviews conducted with staff: 1 Observations by licensing inspector: Inspector reviewed 6 resident records, 3 staff records, observed the physical grounds, observed physician?s orders, Medication Administration Records ( MAR
Based on the review of resident records, the facility did not ensure that an Uniform Assessment Instrument ( UAI
Based on a review of resident records, the facility did not ensure that a sex offender screening from Virginia State Police was obtained for potential resident/resident prior to admission. Evidence: 1) Upon review of resident records, a sex offender screening from Virginia State Police was not included in the records of resident #2 (DOA: 10/25/2016) and resident #4 (DOA: 05/22/1991) 2) Staff #4 confirmed that there were no sex offender screenings prior to residents? admission present in the file of resident #2 and resident #4.
Based on the review of staff records, the facility did not ensure that the initial required staff Tuberculosis risk assessment was completed on or within seven days prior to the first day of work at the facility. Evidence: 1) Upon review of staff record for staff #1 contained a tuberculosis risk assessment dated 9/8/2021 and the start date for staff #1 was 08/11/2020. 2) Upon review of staff records for staff #2 and staff #3 there an initial tuberculosis risk assessment was not included. 3) Staff #4 confirmed that there was not a tuberculosis risk assessment seven days prior or on the first day of work at the facility for staff #1
Based on a review of staff files, the facility did not ensure that there is a registered medication aide licensed by Commonwealth of Virginia to administer medications. Evidence: 1) The staff record of staff #2 included a Virginia Registered Medication Aide license that expired 06/30/2025. 2) Staff #4 confirmed that staff #2?s license was expired upon inspector?s discovery.
Based on a review of resident records, the facility did not ensure that a current picture of the resident is readily available for identification purposes or, if the resident refuses a picture, there shall be a narrative physical description which is annually updated, maintained in his file. Evidence: 1) There was no picture, current or otherwise, included in the resident #2?s record. 2) Staff #4 confirmed that there was not a picture current or otherwise in the record for resident #2.
Based on a review of the facility?s records, the facility did not ensure that the facility had obtained liability insurance coverage for Tier I: A minimum of $250,000 for facilities licensed for 25 residents or fewer Evidence: 1) Staff #4 was unable to produce a Insurance Policy or Insurance Declarations Page upon request from inspector. 2) Staff #4 confirmed that there was not a Insurance Policy or a Declarations Page for liability insurance.
Based on review of resident files, the facility did not ensure that the initial physical and tuberculosis risk assessment were included in the resident file 30 days preceding admission to the facility. Evidence: 1) Upon reviewing record for resident, #1 an initial physical and tuberculosis risk assessment was not included in resident#1 record. Resident #1?s admission date was 06/03/2009. 2) Upon reviewing resident record #2, resident #2 an initial physical and tuberculosis risk assessment was not included in resident #2 record. Resident #2?s admission date was 10/25/2016. 3) Upon reviewing record for resident #4 an initial physical and tuberculosis risk assessment was not included in resident #4 record. Resident #4?s admission date was 05/22/1991 4) Staff #4 confirmed that there was not an initial physical and tuberculosis risk assessment for residents #1, #2 and #4.
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: 09/24/2024 Arrival time: 11:00am Departure time: 1:00pm 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: 20 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 staff: 2 Observations by licensing inspectors: A tour of the facility was conducted to include inside and outside building grounds. Lunch, weekly menu and resident activities were observed. A medication pass observation was completed. The following was reviewed: resident and staff records, emergency preparedness drills, resident fire and resident emergency drills, medication carts, fire inspection report, health inspection report, and a staffing schedule. Water temperature was measured, and the call bell system was monitored. There were some residents who were out at Day Support Programs. However, the inspectors were able to observe residents who remained at the facility watching TV game shows. 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 Shelby Haskins, Licensing Inspector at (804) 305-4876 or by email at Shelby.Haskins@dss.virginia.gov.
Based on a review of staff records it was determined that the facility did not ensure a sworn disclosure statement was included in the staff records. Evidence: 1. There was no original sworn disclosure statement in the staff records for staff #1 and staff #2 during the onsite inspection. 2. Staff # 3 reviewed the records for staff #1 and staff #2 and was unable to provide documentation of the sworn disclosure.
Type of inspection: Complaint Date of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 03/19/2024 10:19am to 11:19am The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. A complaint incident was received by VDSS Division of Licensing on 01/25/2024 regarding allegations in the area(s) of: Resident Care and Related Services, Resident Accommodations and Related Provisions Buildings And Grounds Number of residents present at the facility at the beginning of the inspection: 9 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 0 Number of staff records reviewed: 0 Number of interviews conducted with residents: 0 Number of interviews conducted with staff: 1 Observations by licensing inspector: Upon arrival, the inspector observed one resident in the facility?s common areas watching TV. The administrator informed inspector that the majority of the residents were at a day support program. Additional Comments/Discussion: N/A An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation supported the allegation(s) of non-compliance with standard(s) or law, and violation(s) were issued. Any violation(s) not related to the (complaint(s)/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 Shelby Haskins, Licensing Inspector at (804) 305-4876 or by email at Shelby.Haskins@dss.virginia.gov.
Cats are ferile and there are a vast number of them in and out of the home. Administrator said that there are about 10 on the property and 3 inside of the facility. Inspector discussed how the cats could be carrying disease, illness and possibly rabies.
The inside of the facility was very foul in smell and odor.
Based on the observation of the facility/grounds, it was determined that the facility did not ensure that handrails were provided on all stairways. Evidence 1. The inspector observed that facility did not have handrails on the exterior stairs leading to the front door of the facility. 2. Staff #1 confirmed that there were not handrails on the exterior stairs leading to the front door.
The facility's front door was broken in three places and was not securely locked/closed. There was also a door bell on the front door that was broken and had exposed electrical wires.
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: 10-17-2023, 10:30 ? 11 am; 11-22-2023, 6:50 ? 8 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: 20 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. 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
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: 10-12-2022, 8:39 a.m. ? 10:30 a.m. and 3:00 p.m. ? 3:30 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: 24 Number of resident records reviewed: 6 Number of staff records reviewed: 2 Number of interviews conducted with staff: 1 Observations by licensing inspector: Tour, medication pass, record review 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 observation and interview with staff, the facility failed to ensure the fire and emergency evacuation drawing showed primary and secondary escape routes, areas of refuge, assembly areas, and telephones. Evidence: 1. The fire and emergency drawing observed on the second floor did not contain primary and secondary escape routes, areas of refuge, assembly areas, and telephones. 2. Staff #1 observed during the tour and acknowledged that all required areas were not seen on the drawing. Photographic evidence was obtained.
Based on record review, the facility failed to ensure the written schedule of activities documented the house of the activity. Evidence: The facility?s schedule of activities for August and September 2022 was missing the times for ?Table Games? Activity for dates 8-08-2022, 08-22-2022, and 9-19-2022.
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. Resident #8 was administered Latuda 20 mg on 10-12-2022 during the medication administration observation by licensing staff. 2. A review of Resident #8?s record confirmed there was no documentation of the physician?s order. 3. Staff #1 stated there was not a signed physician?s order on file for or Resident #8?s Latuda 20 mg at the time of inspection.
Based on observation and interview with staff, the facility failed to ensure bedrooms contained an operable bed lamp or bedside light accessible to each resident. Evidence: 1. During a tour of the facility, room 7 and room 12 had four residents each, with no lamp for any of the eight residents. 2. Staff #1 confirmed the bed lamp or bedside lights were not in room 7 or room 12.
Based on record review and interview with staff, the facility failed to ensure individualized service plans ( ISP
A monitoring inspection was conducted on December 10, 2021 to follow up on a previous inspection in the areas of buildings and grounds and resident care and related services. The Administrator was present at the facility during the inspection. The buildings and grounds were observed onsite, and additional required resident documentation was provided by the Administrator. There were no violations found at the time of inspection.
A renewal inspection was initiated on September 8, 2021 and concluded on September 14, 2021. The Administrator was contacted by telephone to initiate the inspection. The Administrator reported that the current census was 24. The inspector emailed the Administrator a list of items required to complete the remote documentation review portion of the inspection. The inspector reviewed 3 resident records, 3 staff records, activities calendars, menus, health and fire inspections, healthcare oversight, dietary and pharmacy oversights, and fire drills submitted by the facility to ensure documentation was complete. The inspector conducted the on-site portion of the inspection on September 10, 2021. An exit interview was conducted with the Administrator on September 14, 2021, 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 non-compliances with applicable standards or law, and violations were documented on the violation notice issued to the facility.
Based on observation and interview with staff, the facility failed to ensure the interior and exterior of all buildings were maintained in good repair and kept clean and free of rubbish. Evidence: 1. During the onsite inspection conducted on 9-10-2021, the following was observed not in good repair nor kept clean and free of rubbish as evidenced by the photographs taken: a. The downstairs shared bathroom contained a loose slab of material leaning against a wall to the left of the toilet covering a hole in the wall. b. A maintenance/storage closet on the second floor had a broken lock with exposed nails protruding out from the door. c. Outside on the grounds, directly outside of a set of four stairs on the backside of the facility were piles of wood, scrap pieces of metal, rusted paint cans, broken furniture, and garbage bags. d. On the back porch on the second floor, the ceiling of the porch was missing leaving an approximately 1 foot long exposed part of ceiling open. 2. Staff #1 confirmed during onsite interview the aforementioned areas were not in good repair nor kept clean and free of rubbish.
Based on record review and interview with staff, the facility failed to ensure the licensed health care professional who provided the health care oversight met the subsection including requirements of subsection B and that the requirements were in writing. Evidence: 1. The health care oversight dated 7-24-2021 did not address subsection B including the following items on the oversight: Ascertain whether a resident's service plan appropriately addresses the current health care needs of the resident; Monitor direct care staff performance of health-related activities; Evaluate the need for staff training; Provide consultation and technical assistance to staff as needed; Review documentation regarding health care services, including medication and treatment records, to assess that services are being provided in accordance with physicians' or other prescribers' orders; Monitor conformance to the facility's medication management plan and the maintenance of required medication reference materials; Evaluate the ability of residents who self-administer medications to continue to safely do so; Observe infection control measures and consistency with the infection control program of the facility. 2. Staff #1 confirmed there were no comments left on the health care oversight to document what was addressed as required and in writing.
Based on observation and interview with staff, the facility failed to ensure certain documents related to the terms of the license were posted on the premises of each licensed facility including the most recently issued license and the findings of the most recent inspection of the facility; Evidence: 1. During the on-site inspection on 9-10-2021, the license posted expired on 10-24-2020. Additionally, the most recent findings from the inspection dated 10-13-2020 were not posted. 2.Staff #1 confirmed during interview the required postings were not posted on-site on the date of the inspection.
Based on record review, observation, and interview with staff, the facility failed to ensure methods to ensure accurate counts of all controlled substances. Evidence: 1. During a medication cart audit on 9-10-2021, Resident #1?s Lorazepam 1 mg contained one extra pill then was supposed to be in the packet. 2. The facility?s medication management plan documented, ?Count the number of pills in each container and confirm that the number of pills in the container is the same as the number on the client.? 3. Staff #1 confirmed that the incorrect number of medications was seen, as there was documented 10 pills but 11 in the packet.
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