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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: 3-11-26 from 2:25 p.m.- 4:10 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: 17 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 Additional Comments/Discussion: The following items were also reviewed/observed- facility documentation, facility postings, first aid kit, medication pass, medication administration records, and physician?s orders. An exit meeting was 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. Your plan of correction must contain: 1) steps to correct the noncompliance with the standard(s), 2) measures to prevent the noncompliance from occurring again; and 3) person(s) responsible for implementing each step and/or monitoring any preventive measure(s). 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 these 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. Refer to General Procedures and Information for Licensure, 22VAC40-80-260-B for information on requesting a problem solving conference. 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 Kimberly Davis, Licensing Inspector at (804) 356-3572 or by email at Kimberly.M.Davis@dss.virginia.gov
Based on a review of facility documentation the facility did not ensure that for each resident assessed for residential living care, except for those who self- administer all of their medications, a licensed health care professional, practicing within the scope of his profession, shall perform an annual review of all the medications of the resident. Evidence: The facility was unable to provide documentation of a medication review of all the medications of the residents. This was confirmed by Staff # 3.
Based on a review of the facility?s first aid kit the facility did not ensure that the first aid kit shall be checked at least monthly to ensure that all items are present and items with expiration dates are not past their expiration date. Evidence: The facility?s last documented review of the first aid kit was dated 12-1-25. This was confirmed by Staff # 3.
Based on a review of resident records the facility did not ensure that the resident's record shall contain the physician's or other prescriber's signed written order. Evidence: 1. The record for Resident # 1 reviewed during medication pass contained a physician?s order sheet that was not signed by the physician or other prescriber. 2. The record for Resident # 2 reviewed during medication pass contained a physician?s order sheet that was not signed by the physician or other prescriber. This was confirmed by Staff # 3.
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: 9-3-25 from 4:30 p.m.-5:15 p.m. 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 regarding allegations in the area(s) of: resident care and accommodations/resident retention. Number of residents present at the facility at the beginning of the inspection: 18 Number of resident records reviewed: 1 Number of interviews conducted with residents: 1 Number of interviews conducted with staff: 2 An exit meeting was conducted to review the inspection findings. 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 Kimberly Davis, Licensing Inspector at (804) 356-3572 or by email at Kimberly.M.Davis@dss.virginia.gov
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: 06/03/2025 arrival time 12:06pm departure time 1:10pm 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 04/18/2025 regarding allegations in the area(s) of: 22VAC40-73-(6) RESIDENT CARE AND RELATED SERVICES, 22VAC40-73-(7) RESIDENT ACCOMMODATIONS AND RELATED PROVISIONS, 63.2-(16) PROTECTION OF ADULTS AND REPORTING and 22VAC40-73-(8) BUILDINGS AND GROUND Number of residents present at the facility at the beginning of the inspection: 0 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 staff: 1 Observations by licensing inspector: Inspector observed all resident bedrooms specifically for bed bug infestation and leaking ceilings, tested water temperature in resident bathrooms, observed food supply and reviewed one resident record. Additional Comments/Discussion: An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation supported some, but not all of the allegation(s); area(s) of non-compliance with standard(s) or law were: 22VAC40-73-(6) RESIDENT CARE AND RELATED SERVICES and 63.2-(16) PROTECTION OF ADULTS AND REPORTING A violation notice was 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.
Based on the review of Resident?s #1?s record and interview with Staff #1, the facility failed to submit a written report of the incident specified in subsection A of this section to the regional licensing office within seven days from the date of the incident. Evidence: 1) There was no written report submitted to the regional licensing office within seven days of the incident for Resident #1?s medical incident in March 2025. 2) Staff #1 confirmed that an incident report was not submitted in reference to Resident #1?s medical incident occurring in March 2025.
Based on the review of Resident #1?s record and interview with Staff #1, the facility failed to report to the regional licensing office within 24 hours any major incident that has negatively affected or that threatens the life, health, safety, or welfare of any resident. Evidence: 1) Based on interviews, resident #1 became ill and had to be transported to hospital by ambulance in March of 2025. The facility never submitted an incident report to this inspector, regional licensing office. 2) Staff #1 could not recall the specific date but confirmed that Resident #1 did go to the hospital by ambulance. Staff #1 also confirmed that an incident report was not submitted in March 2025 at the time of the incident.
Based on review of Resident #1?s record and interview with Staff #1, the facility did not ensure that there is documentation in the resident's record as required by 22VAC40-73-470 F. Evidence: 1) Based on a review of the resident #1?s record, the facility failed to provide documentation in reference to the resident's incident, medical information/hospitalization from the incident of the resident's hospitalization. Resident #1?s record did not include any other type of documentation only facility admissions documentation. 2) Staff #1 confirmed that there was no documentation asides from facility admission documentation in Resident #1?s record.
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: 04/14/2025 arrival time: 2:00pm departure time: 3:15pm 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 02/27/2025 regarding allegations in the area(s) of: 22VAC40-73-(3) PERSONNEL 22VAC40-73-(4) STAFFING AND SUPERVISION 22VAC40-73-(6) RESIDENT CARE AND RELATED SERVICES 22VAC40-73-(7) RESIDENT ACCOMMODATIONS AND RELATED PROVISIONS 22VAC40-80-(G7) COMPLAINT INVESTIGATION Number of residents present at the facility at the beginning of the inspection: 17 Number of staff records reviewed: 5 Number of interviews conducted with staff: 1 Observations by licensing inspector: Inspector observed the facility menus as well as kitchen staff preparing dinner which was meatloaf, string beans and rice. Inspector was also shown the facility?s food supply in the kitchen, deep freezer and the emergency food and water supply that are kept in the facility?s basement. Inspector also reviewed staff records and credentials in reference to the Registered Medication Aides (RMAs), Direct Care Staff on the night shift and the Licensed Practical Nurse (LPN) on staff. Additional Comments/Discussion: An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation did not support the (allegation(s)/self-report) 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 Shelby Haskins, Licensing Inspector at (804) 305-4876 or by email at Shelby.haskins@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: 02/02/2025 Arrival time: 11:07 am Departure time: 2:00 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: 19 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 inspector: A tour of the facility was conducted to include inside and outside building grounds. Residents were out of the facility at the day support program. The weekly menu and resident activities were observed. Water temperature was tested. 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. 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 the evidence, the facility did not ensure that the building was free of infestations of insects and vermin. The grounds shall be kept free of their breeding places. Evidence: 1. Cockroaches were observed in the facility?s kitchen. (Picture # 1) were obtained by the inspector. 2. Dead cockroaches were attached to an adhesive insect trap over the kitchen sink. (Picture #2) were obtained by the inspector.
Based on a review of the evidence, the facility did not ensure that the interior and exterior of all buildings shall be maintained in good repair and kept clean and free of rubbish. Evidence: 1. Upon the inspector?s observation, the primary door to the facility considerable amount of duct tape around the perimeter and was in disrepair. 2. Upon the inspector?s observation, the doorbell to the facility?s entrance was broke and in disrepair. It was attached to the building by duct tape.
Based on a review of the evidence, it was determined that the facility did not ensure all staff records shall be retained at the facility, treated confidentially, and kept in a locked area. Evidence: 1. Staff records were not being stored at the facility. 2. Staff #3 confirmed that the staff records were being stored at his home.
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: 1/19/24 2:00p -4:00p 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: 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: Medication administration and Medication cart audit Additional Comments/Discussion: 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 Tamara Watkins, Licensing Inspector at (804) 662-7422 or by email at tamara.g.watkins@dss.virginia.gov
Type of inspection: Monitoring Date(s) of inspection 3/7/2023 3:30p ? 5:00p. The licensing inspector was on-site at the facility for each day of the inspection. 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: 6 Number of staff records reviewed: 3 Number of interviews conducted with residents: 3 Number of interviews conducted with staff: 3 Additional Comments/Discussion: An exit meeting was conducted to review the inspection findings. Th 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 Tamara Watkins, Licensing Inspector at (804) 662-7422 or by email at tamara.g.watkins@dss.virginia.gov Violation Notice Issued: No
An unannounced renewal inspection was conducted on this date from 9:30 p- 12:00 p. At the time of the inspection there were 18 residents in care. Six resident and three staff files were reviewed as well as other required documentation. All new personnel records were reviewed since the last inspection for criminal history record reports and all were in compliance. Medication administration documentation, activities and meals were observed. Building and grounds were inspected. An exit meeting was held with the Administrator. This inspection determined there were no violations with applicable standards or law. No violations were issued.
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