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Source: VA State Licensing Agency
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: An unannounced monitoring inspection took place on 05/08/2025 at 6:50 am to 9:30 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: 11 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: 2 Observations by licensing inspector: Breakfast and an activity were observed. A medication pass observation was completed for two residents. 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. 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 Donesia Peoples, Licensing Inspector at 757-353-0430 or by email at donesia.peoples@dss.virginia.gov
Based on observation and staff interview the facility failed to ensure the interior and exterior of all buildings be maintained in good repair and kept clean and free of rubbish. Evidence: 1. During a tour of the outside grounds of the facility on 05/08/25, the Licensing Inspector (LI) observed rubbish to include wood debris, and scrap metal. 2. During an interview with staff #3 on 05/08/25, staff #3 acknowledged the items including wood debris, and scrap metal needed to be removed from the outside grounds of the facility.
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 unannounced complaint inspection took place on 12/13/24 from 9:57 am to 10:45 am. The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. A complaint received by VDSS Division of Licensing on 12/09/2024 regarding allegations in the area of: Resident Care and Related Services. 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: 2 Number of staff records reviewed: 0 Number of interviews conducted with residents: 2 Number of interviews conducted with staff: 1 Observations by licensing inspector: Residents were observed in the common areas. Additional Comments/Discussion: An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation did not support the allegations of non-compliance with standard(s) or law. However, violation(s) not related to the complaint 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 Donesia Peoples, Licensing Inspector at 757-353-0430 or by email at donesia.peoples@dss.virginia.gov
Based on observation it was determined that the facility failed to ensure medications shall be stored in a manner consistent with current standards of practice and the storage area shall be locked. Evidence: 1. During a tour of the facility on 12/13/24 at 9:57 am, the Licensing Inspector (LI) observed the medication cart to be unlocked and unstaffed.
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 unannounced renewal inspection took place on 05/16/2024 at 7:44 am to 1:25 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: 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: 6 Number of staff records reviewed: 3 Number of interviews conducted with residents: 1 Number of interviews conducted with staff: 2 Observations by licensing inspector: Lunch and an activity were observed. A medication pass observation was completed for two residents. 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. 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 Donesia Peoples, Licensing Inspector at 757-353-0430 or by email at donesia.peoples@dss.virginia.gov
Based on the onsite record review, it was determined that the facility did not ensure the resident had within the 30 days preceding admission, a physical examination by an independent physician. The report of such examination shall be on file at the assisted living facility and shall contain the following: a statement that the individual does not have any of the conditions or care needs prohibited by 22VAC40-73-310-H. Evidence: 1. Resident?s #3, physical exam dated 05/20/23, did not include a statement that the individual does not have any of the conditions or care needs prohibited by 22VAC40-73-310-H.
Based on the record review the facility failed to ensure on or within 7 days prior to the day of admission, a preliminary plan of care shall be developed to address the basic needs of the resident that adequately protects his health, safety, and welfare. Exception: A Preliminary plan of care is not necessary if a comprehensive individualized service plan ( ISP
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 unannounced renewal inspection took place on 05/16/2023 at 8:15 am to 3:00 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: 11 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: 2 Number of interviews conducted with staff: 2 Observations by licensing inspector: Lunch and an activity were observed. A medication pass observation was completed for three residents. 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. 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 Donesia Peoples, Licensing Inspector at 757-353-0430 or by email at donesia.peoples@dss.virginia.gov
Based on the record review the facility failed to ensure the comprehensive individualized service plan ( ISP
Based on observation the facility failed to implement a written plan for medication management to include methods to prevent the use of outdated medications. Evidence: 1. During observation of the medication cart with staff #3, the following expired medication was located on the medication cart: Simvastatin 20 mg expired 07/31/22.
Based on the staff record review the facility failed to ensure training for medication aides include continuing education required by the Virginia Board of Nursing, Evidence: 1. The Regulations Governing the Registration of Medication Aides by Virginia Board of Nursing, section 18VAC90-60-100-B, state that a medication aide shall have four hours each year of population-specific training in medication administration in the assisted living facility in which the aide is employed; or a refresher course in medication administration offered by an approved program 2. The record for staff #1, a registered medication aide, hire date 12/20/19, did not contain documentation of the staff completing the required annual continuing education or a refresher course in medication administration for the dates of 12/20/19 to 05/16/23. 3. The record for staff #2, a registered medication aide, hire date 05/15/19, did not contain documentation of the staff completing the required annual continuing education or a refresher course in medication administration for the dates of 05/15/19 to 05/16/2023. 4. The record for staff #3, a registered medication aide, hire date 08/15/14, did not contain documentation of the staff completing the required annual continuing education or a refresher course in medication administration for the dates of 08/15/14 to 05/16/23.
Based on observation the facility failed to ensure the hot water at taps available to residents shall be maintained within a range of 105?F to 120?F. Evidence: 1. During the onsite inspection, the water temperature in the women?s shared bathroom was measured 97.0 degrees F. The water temperature in the common area bathroom was measured to 96.6 degrees F.
An unannounced mandated renewal inspection was conducted by two Licensing Inspectors on 4/19/22 and 4/21/22. A tour of the facility was conducted and staff and resident files were reviewed. 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 observations and an interview, the facility failed to ensure changes and substitutions were documented on the posted activities calendar. Evidence: 1. During the on-site inspection on 4/19/22, the scheduled activities listed on the posted calendar were 9:00am-9:30am exercise and 2:20pm-3:30pm coloring. The licensing inspector did not observe the scheduled activities occurring and there were no substitutions documented on the posted calendar. 2. During the on-site inspection on 4/22/22, the scheduled activities listed were again, 9:00am-9:30am exercise and 2:20pm-3:30pm coloring. The licensing inspector did not observe the scheduled activities occurring and there were no substitutions documented on the posted calendar.
Based on record review, the facility failed to ensure when the uniformed assessment ( UAI
An unannounced complaint inspection was conducted by a licensing inspector and a licensing administrator from the Peninsula Regional Office. The inspection was completed on December 17, 2021 from 8:00am to 9:30am. The facility?s census was 15. The complaint addressed concerns regarding the physical plant. Residents and staff were interviewed. Based on the information obtained during this inspection the allegation was valid. The violations were discussed throughout the inspection and during exit interview. Please complete your "plan of correction" and "date to be corrected" for each violation cited on the violation notice and return to me within 10 calendar days. If you have any questions please contact your inspector.
Based on observation and interview the facility failed to store cleaning supplies and other hazardous material in a locked area. Evidence: During an on-site physical inspection of the facility LI observed 1. A circular saw in unlocked room # 11, 2. A five gallon bucket of paint and paint supplies in the sitting room, 3. A wet-dry vacuum, building supplies, and bed bug spray in room #9.
Based on observation and staff interview, the facility failed to post the current license in an area conspicuous to residents and the public. Evidence: The current facility?s license was located in the rear of the facility in the nurse?s station. Staff #2 admitted the framed license was removed from the entrance area due to renovations.
Based on observation and interviews the facility failed to ensure that all fixtures, sinks, bathtubs, and showers are kept clean and in good repair. Evidence: During a physical inspection of the facility with staff # 1, 1. The men?s hallway bathroom was corded and taped off. Staff #1 acknowledged that the bathroom was inoperable because it was being remodeled, however there was evidence that the toilet had been used. 2. The women?s bathroom was observed to have a tub with what appeared to be a cleaning agent sprinkled on the bottom of the tub without being scrubbed or rinsed. 3. Third bathroom had what appeared to be mold around the sink behind the faucet, the flooring near the toilet was cut and peeling, the caulking around the base of the toilet was black, cracking and incorrectly applied, the toilet was peeling, and the molding around the tub was black and rotting.
Based upon observation, the facility failed to have an adequate supply of toilet tissue and soap. Evidence: During a physical inspection there was no soap available in the men?s bathroom or the women?s bathroom.
Based on observation and an inspection of the facility, the facility failed to ensure that each resident room contained a chair for each resident. Evidence: Room #8 had two residents but there were no chairs present.
Based upon observation and interview, the facility failed to ensure the interior and exterior of the building was maintained in good repair and kept cleaned and free of rubbish. Evidence: On 12/17/21, during an inspection of the facility, the following was observed: 1. An inoperable car in the driveway- tags expired as of June 2016; car also had a flat tire; 2. Trash can, mop buckets, and paint roller on the side of the facility; 3. Trash bag in the yard with yard debris; 4. Full size table turned over on front porch; 5. Broken plexiglas on the front porch taped to the railing; 6. Old speaker, hospital tray table, and boards blocking side entrance door; 7. Front porch railing rotted throughout the length of the porch; and 8. Gutters are overflowing with pine needles.
Based on observation and interview made on 12/17/21, the facility failed to post a menu for meals and snack for the current week. Evidence: The facility posted menu was for the week of 12/5/21 through 12/11/21.
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 May 13, 2021 and concluded on May 14, 2021. The Administrator was contacted by telephone to initiate the inspection. The Administrator reported that the current census was 16. The inspector emailed the Administrator a list of items required to complete the inspection. The inspector reviewed 2 resident records, 2 staff records, menus, activities calendar, staff schedules, fire drills, resident council, pharmacy oversight, health and fire inspections, healthcare oversight submitted by the facility to ensure documentation was complete. Information gathered during the inspection determined non-compliance with applicable standards or law, and a violation documented on the violation notice issued to the facility.
Based on record review and discussion, the Uniform Assessment Instrument ( UAI
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