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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: 2/13/2026, 4:50pm-6:45pm 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: 2 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: 1 Number of interviews conducted with residents: 2 Number of interviews conducted with staff: 1 Observations by licensing inspector: Licensing inspector observed the evening medication pass and required facility postings. 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. 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 Tyia Venable, Licensing Inspector at 804-393-2157 or by email at tyia.venable2@dss.virginia.gov
Based on a review of facility documentation, the facility did not ensure fire and emergency evacuation drill frequency and participation was in accordance with Virginia Statewide Fire Prevention Code (13VAC5-51) by conducting drills for each shift in a quarter. Evidence: 1. Licensing inspector reviewed facility documentation, previous fire and evacuation drills were conducted 11/25/25 and 12/25/25. 2. When asked Staff 1 stated no fire and evacuation drill was conducted in January.
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: On 11/27/2024 approximate time 10:02a.m-11:00a.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: 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: 2 Number of staff records reviewed: 1 Number of interviews conducted with residents: N/A Number of interviews conducted with staff: 1 Observations by licensing inspector: Accompanied by the Administrator the LI conducted a walk through of the physical plant. Additional Comments/Discussion: Both residents attend day support programs 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 Angela Rodgers-Reaves, Licensing Inspector at (804) 840-0253 or by email at Angela.r.reaves@dss.virginia.gov Violation Notice Issued: No
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: On 11/14/2023 approximate time 12:50p.m-2:21p.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: none 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: 1 Number of interviews conducted with residents: residents not on site Number of interviews conducted with staff: 1 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 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 Angela Rodgers-Reaves, Licensing Inspector at (804) 840-0253 or by email at angela.r.reaves@dss.virginia.gov Violation Notice Issued: Yes
Based on the review of facility records and staff interview the facility failed to ensure that the medication administration records ( MAR
Based on the review of facility records and staff interview the facility failed to ensure that resident physician orders included a diagnosis. Evidence: Resident # 2 The review of the resident?s physician orders with the Administrator revealed that the physician?s orders for resident # 2 did not include diagnosis for any of the residents prescribed medications
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: 12/15/2022 11:23-12:31 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: 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: 2 Number of staff records reviewed: 1 Number of interviews conducted with residents: 0 Number of interviews conducted with staff: 1 Observations by licensing inspector: N/A 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 Angela Rodgers-Reaves Licensing Inspector at (804) 840-0253 or by email at angela.r.reaves@dss.virginia.go
Based on the review of facility records and interview with the Administrator the facility failed to ensure that for a facility licensed only for residential living care that does not employ a licensed administrator, the administrator attended at least 20 hours of training related to management or operation of a residential facility for adults or relevant to the population in care. Evidence: A copy of this document will be sent to the licensee/provider for signature. The facility Administrator stated during interviews that he had obtained any training hours.
Based on the review of facility records and interview with the Administrator the facility failed to ensure that the fire and emergency evacuation drills are conducted in accordance with the current edition of the Virginia Statewide Fire Prevention Code (13VAC5-51). The drills required for each shift in a quarter shall not be conducted in the same month. Evidence: Facility documentation submitted for the inspector?s review noted that the last fire drill was conducted 06/15/2022
A renewal inspection was initiated on 12/08/2021 and concluded on 01/12/2022. On 12/08/2021 the Administrator was contacted by telephone to initiate the inspection. The facility did not have COVID-19 protocols in place therefore the onsite inspection was terminated on this date. The Administrator reported that the current census was 2. On 01/12/2022 the renewal inspection resumed and the inspector reviewed facility menus, activities calendar, fire inspection, health inspection, physician's orders, medication administration records and the UAI
Based on the review of facility records and interviews conducted with the facility Administrator the facility failed to ensure that a risk assessment for tuberculosis shall be completed annually on each resident as evidenced by the completion of the current screening form published by the Virginia Department of Health or a form consistent with it. Evidence: Resident #1-Documented date of admission 08/15/2018 Resident #2-Documented date of admission 09/19/2018 Facility records submitted for the inspector?s review while onsite on 01/12/2022 revealed that the most recent risk assessment for tuberculosis for resident #1 is dated 10/30/2019. The most recent risk assessment for tuberculosis for resident #2 is dated 12/21/2020.
Based on the review of facility records and the interview with the facility Administrator, the facility failed to ensure that Individualized service plans are reviewed and updated at least once every 12 months and as needed for a significant change of a resident?s condition. The review and update shall be performed by a staff person with the qualifications specified in subsection B of this section and in conjunction with the resident and, as appropriate, with the resident's family, legal representative, direct care staff, case manager, health care providers, qualified mental health professionals, or other persons. Evidence: Resident #1-Documented date of admission 08/15/2018 Resident #2-Documented date of admission 09/19/2018 Facility records submitted for the inspector?s review while onsite on 01/12/2022 revealed that the most recent ISP
Based on the review of facility records and the interview with the facility Administrator, the facility failed to ensure that the facility maintained a written accounting of money received and disbursed by the licensee, facility administrator, or staff person that shows a current balance. The written accounting of the funds shall be made available to the resident at least quarterly and upon request, and a copy shall also be placed in the resident's record. Evidence: Resident #1-Documented date of admission 08/15/2018 Resident #2-Documented date of admission 09/19/2018 The facility Administrator did acknowledge that he received money on a monthly basis for the resident?s care needs but upon request did not submit for the inspector?s review documentation of written monthly accounting of money received and disbursed by the licensee, facility administrator, or staff person that shows a current balance for resident #s 1 and 2.
Based on the interview conducted with the facility Administrator the facility failed to ensure that at least one direct care staff member was on duty at all times in each building when at least one resident is present. Evidence: Resident #1-Documented date of admission 08/15/2018 Resident #2-Documented date of admission 09/19/2018 While outside of the facility on 12/08/2021 the facility Administrator stated during the COVID screening telephone interview that he was not onsite at the facility. The facility Administrator further clarified during this telephone interview that he was the only staff person for the facility and that there were two residents currently onsite and no staff person. For approximately one hour the residents were left at the facility without staff supervision.
Based on the review of facility records and the interview conducted with the facility Administrator the facility failed to ensure that all direct care staff for a facility licensed only for residential living care attended at least 14 hours of training annually. Evidence: Staff #1-Documented date of hire: 06/28/2018 The facility Administrator reported on 01/12/2022 that he is the only staff person currently employed at the facility. Upon request the facility Administrator did not submit for the inspector?s review documentation that he had completed 14 hours of annual training.
Based on the review of facility records and the interview with the facility Administrator, the facility failed to ensure that annual reassessments and reassessments due to a significant change in the resident's condition, using the UAI
Based on observation with the facility Administrator, the facility failed to ensure that all furnishings, fixtures, and equipment, including furniture, window coverings, sinks, toilets, bathtubs, and showers, are kept clean and in good repair and condition, except that furnishings and equipment owned by a resident shall be, at a minimum, in safe condition and not soiled in a manner that presents a health hazard. Evidence: A walkthrough of the facility on 01/12/2022 with the facility Administrator revealed the following: ? First floor bathroom: the shower curtain was observed to have stains; the cabinets of the basin was observed to have water damage; the wall mirror had stains around the base of the mirror and the toilet was observed to have brown stains at the base of the toilet. ? The night side table in bedroom #1 was observed to have dust build up and dust buildup was also observed on the alarm clock and the lamp. The interior furnishings of the facility is not being maintained.
Based on the review of facility records and the interview with the facility Administrator, the facility failed to ensure that at the time the medication is administered, the facility documented on a medication administration record ( MAR
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 monitoring inspection was initiated on 5/4/2021 and concluded on 5/5/2021. The Administrator was contacted by telephone to initiate the inspection. The Administrator reported that the current census was 2. The Inspector emailed the Administrator a list of items required to complete the inspection. The Inspector reviewed 2 residents records, 1 staff record, physician's orders, medication administration records, staff schedule, health care oversight, medication/pharmacy review, fire inspection and fire drills submitted by the facility to ensure documentation was complete. The information gathered during the inspection determined no violations with applicable standards or law. No violations were issued.
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