VIRGINIA DEPARTMENT OF SOCIAL SERVICES

JABA Adult Care Center-Louisa
522 Industrial Drive
Louisa, VA 23093
(540) 967-4432

Current Inspector: Belinda Dyson (804) 662-9780

Inspection Date: June 6, 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 22VAC40-80 THE LICENSE 22VAC40-90 THE SWORN STATEMENT OR AFFIRMATION 22VAC40-90 THE CRIMINAL HISTORY RECORD REPORT

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: 6/6/2023 10:30 a.m.-1:00 p.m. The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. Number of participants present at the center at the beginning of the inspection: 11 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of participant records reviewed: 6 Number of staff records reviewed: 2 Number of interviews conducted with participants: 2 Number of interviews conducted with staff: 4 Observations by licensing inspector: Activities in progress, lunch meal Additional Comments/Discussion: Accompanied by Alisa Foley- Home Office Consultant 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 Belinda Dyson, Licensing Inspector at (804) 662-9780 or by email at belinda.dyson@dss.virginia.gov

Violations:

Standard #:	22VAC40-61-180-E-1
Description:	During a review of staff records, one record reviewed initial TB examination was not completed timely. Evidence: Staff #1 was hired 3/27/2023 and TB test wasn't completed until May 11 2023.
Plan of Correction:	Program Manager will ensure all staff are informed on the first day of employment the need for TB screening/test and ensure results are received within 7 days of employment..
Standard #:	22VAC40-61-220-E
Description:	During a review of participant's records, one record did not have the assessments completed every six months. Evidence: Participant's #2 assessment dates were documented as 9/27/2021 and 5/5/2023.
Plan of Correction:	Program Manager and ADCC nurse will review all participant's charts and update UAIs at six months a nd yearly. Binder spines will be utilized on participant's charts for tracking of due dates for participant's forms and updates.
Standard #:	22VAC40-61-260-C
Description:	During a review of participant's records, one record reviewed did not have a current annual physical examination documented. Evidence: Participant #1 physical examination form is dated May 17, 2022.
Plan of Correction:	Letter informing the family will be sent home on 6/7/2023 informing the need for update of history and physical and ask them to have it completed and returned within 30 days of the letter. Phone call to the caregiver will also be done on 6/7/2023