The Haven Assisted Living @ Mayfield

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: 5/22/2025 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: 6 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: Number of interviews conducted with staff: 2 Observations by licensing inspector: Resident bedrooms, living room, dining area, bathrooms, medication, residents 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) 840-3710 or by email at tamara.g.watkins@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: 2/8/2024 1:15p ? 3:30p 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: 6 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: 3 Number of interviews conducted with staff: 2 Observations by licensing inspector: Staff/resident interaction, medication administration records 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 4/11/2023 from 12:15p ? 1:45p. 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: The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: Number of staff records reviewed: Number of interviews conducted with residents: Number of interviews conducted with staff: Observations by licensing inspector: 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)or by email 662-7422 at tamara.g.watkins@dss.virginia.gov Violation Notice Issued: No

A non-mandated self-report/monitoring inspection was initiated on 3/7/2022 and concluded on 4/5/22. A self-reported incident was received on 2/25/22 by the department regarding allegations in the areas of resident care and related services. A complaint was subsequently received regarding the same issue. The evidence gathered during the investigation supported non-compliance with standards or law, and violations were issued. Any violations not related to the self-report but identified during the course of the investigation can be found on the violation notice. Areas of non-compliance are identified in the Violation Notice. The facility has 10 calendar days from receipt of the inspection reports to complete a plan of correction, sign the inspection report and return them to the licensing office. A copy of the inspection reports shall be retained and posted at the facility. Results of the inspection are subject to public disclosure and will be posted on the VDSS website within 15 calendar days, regardless of whether the plan or correction is completed. The plan of correction shall include the following: (1) Step(s) the facility will take to correct the violations cited; (2) Measures that will be put in place to prevent recurrence of each violation; (3) Person(s) responsible for implementation and monitoring of preventive measures; and (4) Date by which each violation will be corrected.

An unannounced monitoring inspection was conducted on this date from 11:00 p- 12:30 p. At the time of the inspection there were 5 residents in care. Two (2) resident and two (2) 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.