Spring Arbor of Salisbury

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: 11/10/2025 arrival time 10:39am departure time 3:30pm 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: 73 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 6 Number of staff records reviewed: 3 Number of interviews conducted with residents: 1 Number of interviews conducted with staff: 3 Observations by licensing inspector: Inspector reviewed 6 resident records, reviewed 3 staff records, observed a medication administration pass, tour of the building and grounds, reviewed fire and health inspections, reviewed Pharmacy and Medication reviews, reviewed health care oversight, reviewed Dietary/Nutrition review. Observed Emergency Preparedness and Response Plan, reviewed fire drills, Medication Management Plan. Reviewed Infection Control Plan along with reviewing the exercise of the procedures for resident emergencies. Residents were observed moving about the facility going to the dining room for lunch and some were involved in an exercise activity. . Additional Comments/Discussion: 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 Shelby Haskins, Licensing Inspector at (804) 305-4876 or by email at shelby.haskins@dss.virginia.gov. Violation Notice Issued: No

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: 06/16/2025 arrival time 12:11pm departure time 1:40pm The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. A complaint/self-reported incident was received by VDSS Division of Licensing on 05/22/2025 regarding allegations in the area(s) of: 22VAC40-73-(6) RESIDENT CARE AND RELATED SERVICES, 22VAC40-73-(7) RESIDENT ACCOMMODATIONS AND RELATED PROVISIONS and 22VAC40-80-(G7) COMPLAINT INVESTIGATION Number of residents present at the facility at the beginning of the inspection: 74 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of interviews conducted with staff: 3 Observations by licensing inspector: Inspector was able to interview Administrator, Director of Nursing, Home Health Nurse as well as Direct Care Staff assigned to resident. Inspector also reviewed the facility?s complaint report(s) submitted by resident. Inspector was unable to interview resident. Additional Comments/Discussion: N/A An exit meeting will be 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 Shelby Haskins, Licensing Inspector at (804) 305-4876 or by email at shelby.haskins@dss.virginia.gov. Violation Notice Issued: No A copy of this document will be sent to the licensee/provider for signature. Inspector Name: Shelby Haskins Date Inspection Summary Issued: 7/1/2025

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: 04/23/2025 arrival time 11:30am departure time 3:00pm 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: 67 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 6 Number of staff records reviewed: 3 Number of interviews conducted with residents: 1 Number of interviews conducted with staff: 2 Observations by licensing inspector: Inspector completed a Monitoring Inspection. Observed a medication pass, water temperature tested, reviewed fire inspection, reviewed health inspection and had a tour of the building and grounds. Residents were observed at lunch as well as several male residents observed going to attend a Men?s barbecue that was being held on the facility grounds. 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 Shelby Haskins, Licensing Inspector at (804) 305-4876 or by email at Shelby.haskins@dss.virginia.gov. Violation Notice Issued: No A copy of this document will be sent to the licensee/provider for signature. Inspector Name: Shelby Haskins Date Inspection Summary Issued: 5/1/2025

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: 04/23/2025 arrival time 11:30am departure time 3:00pm 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 04/22/2025 regarding allegations in the area(s) of: 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: 67 Number of interviews conducted with staff: 2 Observations by licensing inspector: Inspector reviewed the resident?s Medication Administration Records ( MAR

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: 07/25/2024 Arrival: 9:40am Departure: 10:40am 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 07/08/2024 regarding allegations in the area(s) of: Resident Care and Related Services, Resident Accommodations and Related Provisions, Buildings and Grounds Number of residents present at the facility at the beginning of the inspection: 74 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of interviews conducted with staff: 1 Observations by licensing inspector: The HVAC company was present at the facility repairing the HVAC unit on the 2nd wing of the 400 Hall. There were also fans in the corridors of the 400 Hall. Additional Comments/Discussion: Executive Director informed inspector that the HVAC went out on the 1st wing of the 400 Hall on 07/08/2024. All residents? rooms affected by this on the 400 Hall were immediately provided with window unit air conditioners and fans. 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 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 Mandated Date of inspection the licensing inspector was on-site at the facility for each day of the inspection: 9/26/23, 10:30 a to 1:30 p The Acknowledgement of Inspection form was emailed for each date of the inspection. Number of residents present at the facility at the beginning of the inspection: The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 10 Number of staff records reviewed: 5 Number of interviews conducted with residents: 2 Number of interviews conducted with staff: 3 Observations by licensing inspector: medication administration and storage, resident/staff interactions Additional Comments/Discussion: Facility is undergoing renovations/updates - anticipated completion date is 12/23 An exit meeting was 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 Yvonne Randolph, Licensing Inspector at (x804) 662-7454 or by email at yvonne.randolph@dss.virginia.gov

Type of inspection: Renewal Date of inspection and time the licensing inspector was on-site at the facility: 9:50 a-3:15p 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: 74 The licensing inspector completed a tour of the physical plant. Number of resident records reviewed: 5 Number of staff records reviewed: 4 Number of interviews conducted with residents: 3 Number of interviews conducted with staff: 4 Observations by licensing inspector: activity, lunch, resident/staff interaction, medication passes An exit meeting was 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. Should you have any questions, please contact Yvonne Randolph, Licensing Inspector at 804-662-7454 or by email at yvonne.randolph@dss.virginia.gov Violation Notice Issued: No A copy of this document will be sent to the licensee/provider for signature.

Type of inspection: Complaint. Date of inspection and time the licensing inspector was on-site at the facility for the inspection: 9/12/22 10 a-4 pm The Acknowledgement of Inspection form was provided on the date of the inspection. Technical Assistance: It is suggested that the facility update the resident agreement and/or disclosure statement to include the facility's current protocol regarding wound care by facility staff and meals for hospice residents. Additional Comments: A complaint was received by VDSS Division of Licensing on 8/16/22 regarding allegations in the area of Resident Care and Related Services. Two licensing representatives were present during the inspection. Number of residents present at the facility at the beginning of the inspection: The licensing inspector completed a tour of the resident?s room. Number of resident records reviewed: 1 Number of staff records reviewed:0 Number of interviews conducted with residents:1 Number of interviews conducted with staff: 3 Observations by licensing inspector: lunch meal An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation supported one of the allegations; the area of non-compliance with standards or law was: Resident Care and Related Services - Physician Orders. A violation notice was issued; any violation 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 Yvonne Randolph, Licensing Inspector at 804-441-1180 or by email at yvonne.randolph@dss.virginia.gov