VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Adult Care Center of the Northern Shenandoah Valley, Inc.
411 N. Cameron Street
Suite 100
Winchester, VA 22601
(540) 722-2273

Current Inspector: Jill James (540) 418-2631

Inspection Date: Sept. 28, 2022

Complaint Related: No

Areas Reviewed:

22VAC40-61 GENERAL PROVISIONS 22VAC40-61 ADMINISTRATION 22VAC40-61 PERSONNEL 22VAC40-61 SUPERVISION 22VAC40-61 ADMISSION, RETENTION AND DISCHARGE 22VAC40-61 PROGRAMS AND SERVICES 22VAC40-61 BUILDINGS AND GROUND 22VAC40-61 EMERGENCY PREPAREDNESS 22VAC40-80 THE LICENSE 22VAC40-80 THE LICENSING PROCESS 63.2 GENERAL PROVISIONS 63.2 LICENSURE AND REGISTRATION PROCEDURES 63.2 CRIMINAL PROCEDURES 22VAC40-90 BACKGROUND CHECKS FOR ASSISTED LIVING FACILITIES 22VAC40-90 THE SWORN STATEMENT OR AFFIRMATION 22VAC40-90 THE CRIMINAL HISTORY RECORD REPORT

Technical Assistance:

None.

Comments:

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: 9/28/2022 from approximately 8:40 am to 5:30 pm The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. Number of participants present at the facility at the beginning of the inspection: 7 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of participant records reviewed: 5 Number of staff records reviewed: 4 + selected sections of 5 additional records Number of interviews conducted with participants: 1 Number of interviews conducted with staff: 3 Observations by licensing inspector: Activities, meals, medication administration, emergency food and water, direct care being provided 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 Janice Knight, Licensing Inspector at (540) 430-9258 or by email at Janice.knight@dss.virginia.gov

Violations:

Standard #:	22VAC40-61-100
Description:	Based upon record reviews and interviews, the center failed to ensure two of the four staff records reviewed had a criminal record report (CRR) completed within 30 days of hire. Evidence: 1. Staff 3 (hired 8/8/2022) had no CRR on file. 2. Staff 4 (hired 6/21/2022) had a CRR dated as completed on 8/12/2022. 3. On 9/28/2022, the licensing inspector (LI) interviewed the director who stated the board members had instructed her to hold off on submitting the CRRs due to the money that was lost last year for completing them.
Plan of Correction:	Director has notified the Board of Directors that per state licensing, the center cannot wait 30 days to start CRR on new hires. Director filed the CRR for staff 3 the day she returned to the building (9/29/2022). Going forward, CRRs on new hires will be completed on their first day as part of the orientation and training process. For staff 4, once again, the director and administrative assistant will review all new hire files to ensure that all sections are completed and dated within a timely manner compliant with licensing standards.
Standard #:	22VAC40-61-180-E-1
Description:	Based upon documentation and an interview, the center failed to ensure one of four staff had a tuberculin (TB) skin test/assessment completed 30 days prior to hire or seven days after hire. Evidence: 1. Staff 3 was hired 8/8/2022 and the TB skin test/assessment on file was dated as completed on 3/7/2022. 2. On 9/28/2022, the LI interviewed staff 6 who stated this was the only TB skin test/assessment on file.
Plan of Correction:	Staff member 3 will have a TB assessment performed by the Center registered nurse (RN) on the next day that staff 3 is in Center (9/29/2022) before she starts work on the floor with participants. A chart has been made that will be posted both in the executive director?s office as well as behind the administrative assistant?s desk. The chart contains staff first names and dates of when TB?s are due. Going forward, when a new hire starts at the center, the new hire?s folder will be reviewed by the executive director and administrative assistant to ensure that all sections and dates are correct and completed within the right timeframe.