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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 was completed on 11/20/2025 at 7:10 am to 9:50 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: 8 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 Observations by licensing inspector: A medication pass observation was completed. 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. The call signaling 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 observation and staff interview the facility failed to ensure over-the-counter medication shall remain in the original container, labeled with the resident's name. Evidence: 1. During the medication cart observation with staff #2, the following over the counter medication was located on the cart and was not labeled with a resident?s name: ? Systane Eye drops. 2. During an interview on 11/20/25 with staff #2, staff #2 confirmed the over-the-counter medication, Systane eye drops was not labeled with a resident?s name.
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 was completed on 11/19/2024 at 8:15 am to 10:40 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: 9 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: 3 Number of interviews conducted with staff: 2 Observations by licensing inspector: A medication pass observation was completed. 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. The call signaling 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 record review the facility failed to ensure at the time of discharge, the assisted living facility shall provide to the resident, and as appropriate, his legal guardian and designated contact person a dated statement signed by the licensee or administrator that contains the actions taken by the facility to assist the resident in discharge and relocation process. Evidence: 1. Resident?s #2 discharge statement dated 3/30/24 does not include the following: a) the date on which the resident or legal representative was notified of the discharge. b) the reason for the discharge. c) the actions taken by the facility to assist the resident in the discharge and relocation process. d) the date of the actual discharge from the facility and the resident?s destination.
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 11/02/2023 from 8:35 am to 12:40 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: 9 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: 2 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. 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 checked in two of the resident bathrooms. 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 the comprehensive individualized service plans ( ISP
Based on observation the facility failed to ensure a fire and emergency evacuation drawing shall show primary and secondary escape routes, areas of refuge, and assembly areas. Evidence: 1. During a tour of the facility with staff #2 the fire and emergency evacuation drawings posted in the facility did not show primary and secondary escape routes, areas of refuge, and assembly areas.
Based on observation and staff interviewed, the facility failed to ensure the telephone numbers for the fire department, rescue squad or ambulance, police, and Poison Control Center shall be posted by each telephone shown on the fire and emergency evacuation plan. Evidence: 1. During a tour of the facility with staff #2, a listing of the telephone numbers for the fire department, rescue squad or ambulance, police, and poison control was not posted near the telephone shown on the facility?s fire and emergency evacuation plan. 2. Staff #2 confirmed the telephone numbers for the fire department, rescue squad or ambulance, police, and poison control was not posted near the telephones in the facility.
Based on the record review the facility failed to ensure in accordance with 63.2-1805 D of the Code of Virginia, assisted living facilities shall not admit or retain individuals with any of the following conditions or care needs: psychotropic medications without appropriate diagnosis and treatment plans. Evidence: 1. The record for resident #1, admitted 12/25/22, contains a physician order dated 11/23/22 and a physical exam dated 12/23/22 prescribing the following medication: Bupropion ER 150mg, to give every 12 hours for depression. Resident?s #1 record did not contain a treatment plan dated prior to or on admission for the psychotropic medication, Bupropion.
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 10/11/22 from 8:45 am to 3:22 pm. The Acknowledgement of Inspection form was signed and left at the facility. Number of residents present at the facility at the beginning of the inspection: 10 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: 2 Number of interviews conducted with residents: 3 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. 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 plan, medication carts for assisted living, fire inspection report, health inspection report, and a staffing schedule. Water temperature was checked in two of the resident bathrooms. Additional Comments/Discussion: The facility is currently staffed with two employees. 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 staff record review the facility failed to ensure when adults with mental impairments reside in the facility, at least four of the training hours required annually focus on topics related to residents? mental impairments. Evidence: 1. The record for Staff #1(hired 01/01/12) and Staff #2 (hired 01/01/12) did not document 4 hours of annual training in mental impairments. 2. The record for resident #1 documents a mental impairment of schizoaffective and bipolar disorder. 3. The record for resident # 3 documents a mental impairment of schizoaffective disorder. 4. Staff # 1 and staff #2 acknowledged there is no evidence they received 4 hours of annual training in mental impairments.
Based on the medication pass observation the facility failed to implement a written plan for medication management to include methods to prevent the use of outdated medications. Evidence: 1. LI observed the following expired medications on a medication cart at the facility: Reguloid Capsule and MAPAP PM expired 07/03/2022 for resident # 4.
Based on observation during an onsite tour of the facility the facility failed to post ?No Smoking-Oxygen In Use? signs in any room of a building where oxygen is in use. Evidence: 1. Resident # 5 room contained an oxygen tank. 2. Staff #2 acknowledged resident #5 is prescribed the use of oxygen. 3. Staff # 2 acknowledged the oxygen in use sign was not placed in the room of resident #5 during the tour of the facility.
Based on record review the facility failed to ensure individualized service plans ( ISP
Based on record review the facility failed to ensure a risk assessment for tuberculosis (TB) shall be completed annually on each resident. Evidence: 1. In the record of resident #2, the most recent TB risk assessment is dated 09/09/21.
Based on the onsite record review and staff interview the facility failed to ensure in a facility licensed only for residential living care, all direct care staff shall attend at least 14 hours of training annually.(Exception: Direct care staff who are licensed health care professions or certified nurse aides shall attend at least 12 hours of annual training). Evidence: 1. The record for Staff #2, a certified nurse aide hired 01/01/12 did not include documentation of 12 hours of annual training. The last date of training documented in the record for staff #2 is 09/29/21. 2. Staff #2 acknowledged there is no record of documentation that she received 12 hours of training annually.
Based on record review the facility failed to ensure at the time of discharge, the assisted living facility shall provide to the resident, and as appropriate, his legal guardian and designated contact person a dated statement signed by the licensee or administrator that contains the actions taken by the facility to assist the resident in discharge and relocation process. Evidence: 1. Resident #8 discharge statement dated 09/23/22 did not include documentation of the actions taken by the facility to assist the resident in discharge and relocation process.
An initial renewal inspection was initiated on 10-31-21 and concluded on 11-8-21. The administrator in charge was contacted by telephone to initiate the inspection. The administrator reported that the current census was 9. The inspector emailed the administrator a list of items required to complete the remote documentation review portion of the inspection. The inspector reviewed two resident records, two staff records, activities calendar, facility menu, staff schedule, health care oversight, pharmacy review, nutritional report, healthcare oversight and fire drills submitted by the facility to ensure documentation was complete. The inspector conducted the on-site portion of the inspection on 11-5-21. An exit interview was conducted on 11-3-21 and 11-8-21 where findings were reviewed and an opportunity was given for questions, as well as for providing any information or documentation which was not available during the inspection.
Based on record review and staff interview, the facility failed to ensure when medication aides administer the PRN
Based on record reviewed, document reviewed and staff interviewed, the provider failed to ensure it did not retain anyone prescribed a psychotropic medication without a treatment plan for one of two residents. Evidence: 1. Resident #2`s October?s 2021 medication administration record ( MAR
Based on document reviewed and staff interviewed, the facility failed to ensure the physician or other prescriber orders, both written and oral, for administration of all prescription and over-the counter medications include the diagnosis, condition, or specific indications for administering the drug. Evidence: 1. Resident #2?s physician?s order dated 6-15-21 for aripiprazole (Abilify) did not include a diagnosis, condition, or specific indications. 2. On 11-8-21 during exit interview, staff #2 acknowledged the physician order did not include the diagnosis.
Based on record review and staff interview, the facility failed to ensure when adults with mental impairments reside in the facility, at least four of the required hours shall focus on topics related to residents? mental impairments. Evidence: 1 Staff #2?s record did not include documentation of four hours of required training in mental impairments. 2. On 11-3-21 and 11-8-21 during exit interviews, staff #2 acknowledged not having documentation of mental health training.
Based on record reviewed and staff interviewed, the facility failed to ensure, either directly or indirectly, that the health care service needs of a resident was met. Evidence: 1. Resident #1?s admission physical examination dated 12-27-20 documented ?physical therapy for strengthening and keeping resident?s balance?. 2. Resident?s individualized service plan did not include documentation of services provided since admission. Staff #2 stated during interview, resident #1 uses a cane when walking outside of the facility. 3. Interview with staff #2 revealed resident #2 did not have physical therapy services. 4. On 11-3-21 and 11-8-21, staff #2 acknowledged resident did not received physical therapy services.
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