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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 unannounced renewal inspection took place on 11/05/2025 from 8:42 am to 3:52 pm and 11/07/2025 from 10:05 am to 10:20 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: 29 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: 2 Observations by licensing inspector: Breakfast and lunch were observed. A medication pass observation was completed for three residents. The following were 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: None 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 and staff interview the facility failed to ensure within the 30 days preceding admission, a person shall have a physical examination by an independent physician. The report of such examination shall be on file at the assisted living facility, Evidence: 1. The record for resident #3, admission date 07/07/25, does not contain a physical examination completed within 30 days prior to the resident?s admission to the facility. Resident #3?s physical examination is dated as completed 8/05/25. 2. Upon request, and during an interview on 11/05/25 with staff #4, staff #4 confirmed the physical exam in the record is dated as completed on 08/05/25 and staff #4 was not able to provide a physical examination completed with 30 days of admission for resident #3.
Based on the record review and staff interview the facility failed to ensure the comprehensive individualized service plan ( ISP
Based on the record review and staff interview the facility failed to ensure each direct care staff member who does not have current certification in first aid as specified in subdivision 1 of this subsection shall receive certification in first aid within 60 days of employment. Evidence: 1. The record for staff # 1 contains a first aid certification dated 03/02/2023 and valid for 2 years. 2. Upon request, and during an interview on 11/05/2025 staff #4 was not able to provide evidence staff #1 has a current certification in first aid.
Based on observation, and staff interviews the facility failed to ensure in buildings licensed to care for 20 or more residents under one roof, there shall be a signaling device that terminates at a central location that is continuously staffed and permits staff to determine the origin of the signal or is audible and visible in a manner that permits staff to determine the origin of the signal. Evidence: 1. During a tour of the facility on 11/05/2025 the Licensing Inspector (LI) did not observe a signaling device that terminates to a central location that is continuously staffed and permits staff to determine the origin of the signal. The facility has a census of 29 residents. 2. During an interview on 11/05/25 with staff #4, staff #4 confirmed the signaling device used to alert staff was disconnected and not in use as of 11/03/25.
Based on observation and staff interview the facility failed to ensure medications shall be stored in a manner consistent with current standards of practice. The storage area shall be locked. Evidence: 1. During a tour of the facility on 11/05/2025 at 8:44am, the Licensing Inspector (LI) observed the medication cart to be unlocked and unstaffed. 2. During an interview on 11/05/2025 with staff #1, staff #1 confirmed staff #1 left the medication cart unlocked and unstaffed at the time of 8:44am.
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 11/05/2025 from 8:42 am to 3:52 pm. 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 10/27/2025 regarding allegations in the area(s) of: Resident care and Related Services. Number of residents present at the facility at the beginning of the inspection: 29 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: 0 Number of interviews conducted with residents: 2 Number of interviews conducted with staff: 2 Observations by licensing inspector: An observation of breakfast and lunch was completed. Additional Comments/Discussion: None An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation did not support the (compliant) 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 (Donesia Peoples), Licensing Inspector at (757) 353-0430 or by email at donesia.peoples@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: An unannounced complaint inspection took place on 11/05/2025 from 8:42 am to 3:52 pm. 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 10/27/2025 regarding allegations in the area(s) of: Resident care and Related Services. Number of residents present at the facility at the beginning of the inspection: 29 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: 0 Number of interviews conducted with residents: 2 Number of interviews conducted with staff: 2 Observations by licensing inspector: An observation of breakfast and lunch was completed. Additional Comments/Discussion: None An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation did not support the (compliant) 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 (Donesia Peoples), Licensing Inspector at (757) 353-0430 or by email at donesia.peoples@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: An unannounced complaint inspection took place on 11/05/2025 from 8:42 am to 3:52 pm. 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 09/25/2025 regarding allegations in the area(s) of: Resident care and Related Services. Number of residents present at the facility at the beginning of the inspection: 29 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: 0 Number of interviews conducted with residents: 2 Number of interviews conducted with staff: 2 Observations by licensing inspector: An observation of breakfast and lunch was completed. Additional Comments/Discussion: None An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation did not support the (compliant) 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 (Donesia Peoples), Licensing Inspector at (757) 353-0430 or by email at donesia.peoples@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: An unannounced complaint inspection took place on 11/05/2025 from 8:42 am to 3:52 pm. 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 10/27/2025 regarding allegations in the area(s) of: Resident care and Related Services and Buildings and Grounds. Number of residents present at the facility at the beginning of the inspection: 29 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: 0 Number of interviews conducted with residents: 2 Number of interviews conducted with staff: 2 Observations by licensing inspector: Breakfast and lunch were observed. Additional Comments/Discussion: None An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation supported some, but not all of the allegations; area(s) of non-compliance with standard(s) or law were: Resident Care and Related Services A violation notice was issued; any violation(s) not related to the complaint 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 Donesia Peoples, Licensing Inspector at 757-353-0430 or by email at donesia.peoples@dss.virginia.gov
Based on the record review and staff interview the facility failed to ensure individualized service plans ( ISP
Based on the record review and staff interview the facility failed to ensure the Uniform Assessment Instrument ( UAI
Based the record review and staff interview the facility failed to ensure for private pay individuals, the assisted living facility shall ensure that the uniform assessment instrument is completed as required by 22VAC30- 110. Evidence: 1. The record for resident #2 contains a UAI
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 08/12/2025 at 10:25 am to 11:00 am. 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 08/01/2025 regarding allegations in the area(s) of: Resident care and Related Services and Buildings and Grounds Number of residents present at the facility at the beginning of the inspection: 28 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: 3 Number of interviews conducted with staff: 1 Observations by licensing inspector: An observation of the facility?s food and snack supply was completed. Records for maintenance of buildings and groups were completed. Additional Comments/Discussion: None 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, violations 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. 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
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 03/21/2025 from 11:09 am to 12:50 pm. The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. A self-report was received by VDSS Division of Licensing on 03/12/2025 regarding allegations in the area of: Resident Care and Related Services The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of residents present at the facility at the beginning of the inspection: 26 Number of resident records reviewed: 2 Number of staff records reviewed: 0 Number of interviews conducted with residents: 0 Number of interviews conducted with staff: 3 Observations by licensing inspector: Residents were observed in the common areas. Additional Comments/Discussion: None An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation supported the self-report of non-compliance with standard(s) or law, and violation(s) were issued. Any violation(s) not related to the 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 Donesia Peoples, Licensing Inspector at 757-353-0430 or by email at donesia.peoples@dss.virginia.gov
Based on the record review and staff interview the facility failed to assume the general responsibility for the health, safety, and well-being of the residents. Evidence: 1. Staff #1 submitted the following incident report via email to the Licensing Inspector on 03/12/25: ?resident #1 attempted to place a pillow over resident?s #1 roommate head and used a cigarette lighter to burn the night lamp cord. Resident #1 punched staff #2 in the face, resulting in visible swelling.? 2. Resident?s #2 progress note dated 03/12/25 documents the following: ?resident #2 complained about resident #1 behavior of talking abusively, threatening to fight resident #2? Resident #1 took the lamp and told resident #2, resident #1 will burn down the place. Resident #1 attempted to place a pillow over the head of resident #2. 3. During an interview on 03/21/25, with staff #2, staff #2 acknowledged on the day of 03/12/25, resident #2 reported to staff #2 that resident #1 attempted to place a pillow over the head of resident #2 and staff #2 observed a burned lamp cord located in residents #1 and #2 room. Staff #2 contacted the police and the police officer removed resident # 1 from the facility.
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 10/15/2024 from 8:00 am to 2:37 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: 27 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 residents: 2 Number of interviews conducted with staff: 2 Observations by licensing inspector: Breakfast and lunch were observed. A medication pass observation was completed for two residents. The following was reviewed: resident and staff records, medication carts, fire inspection report, health inspection report, and a staffing schedule. The call bell system was monitored. Additional Comments/Discussion: None 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 individualized service plans ( ISP
Based on the record review the facility failed to ensure each staff person on or within 7 days prior to the first day of work at the facility prior to coming in contact with residents shall submit the results of a risk assessment documenting the absence of tuberculosis (TB) 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. The risk assessment shall be no older than 30 days. Evidence: 1. The record for staff #3, hire date of 5/02/24, did not contain a risk assessment for TB completed on or within 30 days prior to the first day of work. 2. The record for staff #3 contains a risk assessment for TB dated 7/18/24. 3. Staff #4 reviewed the record for staff #3 and was not able to provide documentation of a risk assessment for TB completed on or 30 days prior to staff #3?s first day of work.
Based on review the facility failed to ensure fire and emergency drill frequency and participation shall be in accordance with the current edition of the Virginia Statewide Fire Prevention Code (13VAC5-51). The drills requested for each shift in a quarter shall not be conducted in the same month. Evidence: 1. Staff #4 was unable to provide evidence of fire and emergency evacuation drills completed in each shift for every quarter for the year of 2024. 2. Staff #4 provided documentation of a fire drill completed on 8/14/23, 10/01/24, and 10/02/24.
Based on the onsite record review, it was determined that the facility failed to ensure within the 30 days preceding admission, a person shall have a physical examination by an independent physician and shall contain all included in this section (22VAC40-73-320-A). Evidence: 1. The record for resident #1, admission date of 7/01/24, contains a physical exam dated 5/31/24, and it did not include the following: A statement that the individual does not have any of the conditions or care needs prohibited by 22VAC40-73-310-H (airborne infectious diseases, psychotropic medications, and continuous licensed nursing care). 2. The record for resident #2, admission date of 3/19/24, contains a physical exam dated 03/01/24 and it did not include the following: The resident?s address; a statement that the individual does not have any of the conditions or care needs prohibited by 22VAC40-73-310-H; a statement that specifies whether the individual is considered to be ambulatory or nonambulatory; a statement that specifies whether the individual is or is not capable of self-administering medication.
Based on the record review the facility failed to ensure each direct care staff member who does not have current certification in first aid as specified in subdivision 1 of this subsection shall receive certification in first aid within 60 days of employment. Evidence: 1. The record for staff #1 (personal care aide), hire date of 6/30/24, did not contain documentation of a certification in first aid. 2. The record for staff #3 (personal care aide), hire date of 5/02/24, did not contain documentation of a certification in first aid. 3. Staff #4 reviewed the records for staff #1 and staff #3 and was not able to provide documentation of certification in first aid for staff #1 and staff #3.
Based on review the facility failed to ensure the facility shall review the emergency preparedness plan annually. Evidence: 1. Staff #4 was unable to provide documentation of an annual review of the facility?s emergency preparedness plan.
22VAC40-73-970-E Based on the record review the facility failed to ensure a record of the require fire and emergency evacuation drills shall include the items as listed in this subsection: Evidence: 1.The facility?s record of fire drill dated 10/01/24 did not include the following: time of the drill, number of staff and residents participating, and weather conditions. 2. The facility?s record of fire drill dated 10/02/24 did not include the following: time of the drills and weather conditions.
Based on the record review the facility failed to ensure the comprehensive individualized plan ( ISP
Based on the onsite review and staff interview the facility failed to ensure at least every six months, all staff currently on duty on each shift shall participate in an exercise in which the procedures for resident emergencies are practiced. Documentation of each exercise shall be maintained in the facility for at least two years. Evidence: 1. Staff #4 was unable to provide documentation of staff participation in an exercise in which the procedures for resident emergencies were practiced every 6 months.
Based on the onsite record review, it was determined that the facility failed to implement a written plan for medication management to include: methods to prevent the use of outdated, damaged, or contaminated medications Evidence: 1. During the medication cart observation with staff #2, the following medication for resident #5 was located on the medication cart: Sodium Chloride, expired 7/16/24.
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