VIRGINIA DEPARTMENT OF SOCIAL SERVICES

JABA Adult Day Care Center
674 Hillsdale Drive
Suite #9
Charlottesville, VA 22901
(434) 817-5235

Current Inspector: Belinda Dyson (804) 662-9780

Inspection Date: June 8, 2023 and June 14, 2023

Complaint Related: No

Areas Reviewed:

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 22VAC40-90 BACKGROUND CHECKS FOR ASSISTED LIVING FACILITIES 22VAC40-90 THE SWORN STATEMENT OR AFFIRMATION 22VAC40-90 THE CRIMINAL HISTORY RECORD REPORT

Comments:

Type of inspection: Monitoring An on-site unannounced mandated monitoring inspection was conducted by Licensing administrator (LA) and two Licensing inspectors from the Peninsula Licensing Office. Arrival time: 09:50 a.m. Census 22. The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection was signed and dated by the Program Manager (Director) on 6-8-23. 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 (Willie Barnes), Licensing Inspector at (757) 439-6815 or by email at willie.barnes@dss.virginia.gov

Violations:

Standard #:	22VAC40-61-150-A
Description:	Based on record reviewed and staff interviewed, the facility failed to staff attended at least 12 hours of training annually. Evidence: 1. On 6-8-23, staff member #7 did not have documentation of 12 hours of annual training.
Plan of Correction:	Staff member has been enrolled in Relias CEU training modules. Staff member will be assigned continuing education modules on a monthly basis to remain current on required training.
Standard #:	22VAC40-61-180-E-2
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure staff was screened annually in accordance with the subdivision 1 of 22VAC40-61-180, with the exception of that annual chest s-rays are not required in the absence of symptoms for those with prior positive test results for TB infection (tuberculin skin test or interferon gamma release assay blood test). Evidence: 1. On 6-8-23, staff #7, did not have documentation of an annual TB screening result.
Plan of Correction:	TB Screen was completed on site to be in compliance with regulations.
Standard #:	22VAC40-61-230-D
Description:	Based on record review, the center failed to ensure the plan of care be developed to maximize the participant's level of functional ability and to support the principles of individuality, personal dignity, and freedom of choice and include the items listed in the standard. Evidence: 1. The plan of care for Participant #4 dated 4-20-23 did not include a complete listing of the participants allergies. According to the participant?s physical dated 3-29-23, the participant is allergic to Hydro morphine and Pollen. The allergens were not listed on the plan of care. The 3-29-23 physical also stated the participant should be on a no concentrated sweets diet and the plan of care stated the participant?s diet was regular.
Plan of Correction:	ACC Nurse will review history and physical of all participants when creating a plan of care. ACC Program Manager will review plan of cares to ensure that pertinent medical history is outlined prior to obtaining signatures.
Standard #:	22VAC40-61-230-E
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure the plan of care was reviewed and updated as significant changes occur and at least every six months for two of six records. Evidence: 1. On 6-8-23, the last documented review of participant #5 plan of care in the record was dated 9-20-22. 2. Participant #6 plan of care was last dated 8-30-22.
Plan of Correction:	ACC Nurse and Administrative Assistant will complete a monthly audit of all participant files to ensure that care plans are updated and signed, per state regulation requirements.
Standard #:	22VAC40-61-230-F
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure the participant plan of care was also signed and dated by the participant, family member, or legal representative for four of six records reviewed. Evidence: 1. On 6-8-23, participant #1?s plan of care was not signed or dated by the participant, family member, or legal representative. 2. Participant #2?s plan of care was not signed or dated by the participant, family member, or legal representative. 3. Participant #3?s plan of care was not signed or dated by the participant, family member, or legal representative. 4. Participants #4?s plan of care was not signed and dated by the participant, family member, or legal representative.
Plan of Correction:	Upon completion of care plan, ACC Nurse will communicate with participant?s family to review document. ACC Nurse will provide the original of care plan to family for signature. ACC Nurse will file a copy of care plan in participant?s file with a note documenting date signature was requested. ACC Nurse will provide family a 7 day window to review care plan and return to center.
Standard #:	22VAC40-61-260-B
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure it obtained an evaluation by a qualified licensed practitioner that completes an assessment of tuberculosis (TB) in a communicable form no earlier than 30 days before admission. Evidence: 1.On 6-8-23, participant #3?s record did not include documentation of an assessment of tuberculosis (TB) no earlier than 30 days before admission. The participant?s start date on the agreement form was dated 4-4-23. The initial start date on the Individualized service plan (plan of care) was dated 5-8-23. 2. The TB section on the physical examination form dated 4-7-23 was blank. 3. Staff #1 acknowledged the participant?s record did not include a completed TB form prior to initial start date.
Plan of Correction:	Upon admission to the program, ACC Program Manager will review history and physical documents to ensure all information is provided. Admission to ACC program will be delayed until all required documentation is received. TB screen will be obtained from physician and filed in participant?s chart.
Standard #:	22VAC40-61-340-B
Description:	Based on document reviewed and staff interviewed, the facility failed to ensure when any portion of the adult day care is subject to inspection by the Virginia Department of Health, the center shall be in compliance with those regulations, as evidence by an initial and subsequent annual report from the Virginia Department of Health. Evidence: 1. On 6-8-23, the facilities health inspection document was dated 3-3-22. 2. Staff #8 stated the inspection was completed every 2 years, staff stated placing a call the health department, but did not have documentation of communication with the Health Department regarding the need for a health inspection.
Plan of Correction:	ACC Program Manager will contact Department of Health annually to request an annual inspection. ACC Program Manager will maintain documentation of requests on file.
Standard #:	22VAC40-61-360-B
Description:	Based on document reviewed and staff interviewed, the facility failed to ensure that menus for meals and snacks for the current week was dated and posted in an area conspicuous to participants. Evidence: 1. On 6-8-23, during a tour of the facility, the inspector noticed the breakfast and snack menus for the current week was not posted in the facility. 2. Staff #6 acknowledged the menu posted did not contain the breakfast and snack items.
Plan of Correction:	ACC Program Manager has listed daily available meals, snacks, and beverage options. Listings are posted in a location that is easily accessible by staff members, participants, family members, and guests.