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 20, 2023

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

Technical Assistance:

1. Labeling of glucometer 2. Dates of completion of service plans 3. DNR goal on service plan

Comments:

Type of inspection: Monitoring Date of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 6-20-23, 9:40 a m to 11:00 am The Acknowledgement of Inspection form was signed and left at the facility for the date of the inspection. Number of participants present at the facility at the beginning of the inspection: 17 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of participant records reviewed: 2 Medication observations: 2 Number of staff records reviewed: 0 Number of interviews conducted with participants: 2 Number of interviews conducted with staff: 2 Observations by licensing inspector: Postings, medication storage and administration, breakfast meal, activities, building and grounds Additional Comments/Discussion: Two previous on-site inspections were conducted on 6/8/23 and 6/14/23. All staff records were reviewed during previous inspections. Previous violation (350.B - posting of breakfast and snack menus) correction made as agreed upon. An exit meeting will be conducted to review the inspection findings. The evidence gathered during the inspection determined a non-compliance with applicable standard or law, and the violation is 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 will be addressed in order to return the facility to compliance and maintain future compliance with applicable standard 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

Violations:

Standard #:	22VAC40-61-360-B-1
Description:	Based on a review of the posted menu and observation of the breakfast meal, menu substitutions were not recorded on the posted menu. Evidence: The breakfast meal observed and served was not recorded on the posted menu.
Plan of Correction:	Program Manager has obtained the most up-to-date am/pm snack menu from the dietary department. Assistant Manager will post monthly snack options at the time the monthly calendar and menus are posted. Assistant Manager will note any changes to snack on monthly calendar. Monthly snack calendar will be reported to Program Manager at the end of each month for review.