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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 was conducted on August 21, 2025, between approximately 11:00 AM and 1:30 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: Four 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: 1 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 Coy Stevenson, Licensing Inspector at (804) 972-4700 or by email at coy.stevenson@dss.virginia.gov.
The facility did not obtain a copy of the certificate issued, or other documentation, within Two (2) months of being hired, showing that all employees of the facility have met at least one of the requirements outlined under 22VAC40-73-250.C Evidence: 1) A review of the record for Employee #1 did not contain documentation showing they meet the qualifications of their position as outlined under 22VAC40-73-250.C. Employee #2 meets the definition of Direct Care Staff. 2) The hire date listed in the record for Employee #1 lists their hire date as June 01, 2024.
The facility did not ensure that within 30 days of admission, all residents have a comprehensive individualized service plan created. Evidence: 1) Resident #1 was admitted to the facility on April 27, 2025. 2) A review of the record for Resident #1 did not contain a comprehensive individualized service plan that was developed within 30 days of admission. 3) The on-site inspection occurred on August 21, 2025.
The facility did not ensure that each staff person provides documentation on or within seven days prior to the first day of work, the results of a risk assessment, documenting the absence of tuberculosis in a communicable form, as evidenced by the completion of the current screening form published by the Virginia Department of Health or a form consistent with it. Evidence: 1) Employee #2 was hired on March 15, 2025. 2) A review of the record for Employee #2 conducted during the on-site review on August 21, 2025, did not contain a risk assessment documenting the absence of tuberculosis in a communicable form, as evidenced by the completion of the current screening form published by the Virginia Department of Health or a form consistent with it.
A resident was admitted before a determination has been made that the facility can meet the needs of the individual. The facility shall make the determination based in part upon a physical examination completed by an independent physician within 30 days of admission. Evidence: 1) Resident #1 was admitted on April 27, 2025. 2) A review of the record for Resident #1 did not contain documentation showing Resident #1 underwent a physical examination by an independent physician within 30 days of admission.
Prior to admission of a resident, the assisted living facility administrator did not provide written assurance to the resident that the facility has the appropriate license to meet his care needs at the time of admission. Evidence: Prior to admission of a resident, the assisted living facility administrator did not provide written assurance to the resident that the facility has the appropriate license to meet his care needs at the time of admission. Evidence: 1) The Uniform Assessment Instrument ( UAI
The facility did not ensure that within 30 days preceding admission, all resident have physical examination by an independent physician. Evidence: 1) A review of the record for Resident #1 did not contain documentation showing that Resident #1 had a physical examination by an independent physician, within 30 days of admission.
The facility did not ensure that on, or within seven days prior to the day of admission, a preliminary plan of care was developed for all residents, to address their basic needs, and that adequately protects their health, safety, and welfare. Evidence: 1) Resident #1 was admitted to the facility on April 27, 2025. 2) A review of the record for Resident #1 did not contain an initial individualized service plan that was developed within 7 days of admission. 3) The on-site inspection occurred on August 21, 2025.
The facility did not ensure that prior to admission, all residents are assessed face to face using the Uniform Assessment Instrument in accordance with Assessment in Assisted Living Facilities (22VAC30-110). Evidence: 1) A review of the record for Resident #1 contained a Uniform Assessment Instrument ( UAI
The facility did not ensure that a criminal history report was obtained no later than the 30th day of employment for each employee. Evidence: 1) A review of the record for Employee #1 notes their hire date was June 01, 2024. 2) A review of the record for Employee #2 notes their hire date was March 14, 2025 3) At the time of the on-site review on August 21, 2025, there was no criminal history report in either record for Employee #1?s or Employee #2.
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