VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Adult Care Center of Roanoke Valley
2321 Roanoke Boulevard
Salem, VA 24153
(540) 981-2350

Current Inspector: Angela Marie Swink (276) 623-6575

Inspection Date: June 22, 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 22VAC40-80 THE LICENSING PROCESS 22VAC40-80 SANCTIONS 63.2 GENERAL PROVISIONS 63.2 PROTECTION OF ADULTS AND REPORTING 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

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: 06/22/2023 10:00am until 1:00pm 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: 22 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of participant records reviewed: 3 Number of staff records reviewed: 3 Number of interviews conducted with participants: 1 Number of interviews conducted with staff: 3 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 Cynthia Ball-Beckner, Licensing Inspector at 540-309-2968 or by email at Cynthia.ball@dss.virginia.gov

Violations:

Standard #:	22VAC40-61-230-D
Description:	Based on review of participant records, the facility failed to ensure that identified needs were identified on participant plan of cares (POC). EVIDENCE: 1. The record for participant 2 had a signed Do not Resuscitate (DNR) dated 02/02/2023. The history and physical completed on 03/23/2023 has documentation that the participant is on a low salt, diabetic diet and is to wear TED Hose daily. The POC dated 03/02/2023 in the record for participant 2 does not address these identified needs.
Plan of Correction:	The Care Plan, dated 03/02/2023,for participant 2 was updated to reflect the identified needs of DNR, low salt / diabetic diet and TED hose daily. All Care Plans will be reviewed/ audited, by 7/03/23, for identified needs.
Standard #:	22VAC40-61-300-H
Description:	Based on review of participant records, the facility failed to ensure that medical treatments were documented. EVIDENCE: 1. The history and physical dated 03/23/2023 in the record for participant 2 has documentation of blood sugar checks being ordered for 3 times a day. The June 2023 medication administration record (MAR) for participant 2 does not have a recording of the results of blood sugar checks conducted while at the facility.
Plan of Correction:	The MAR, for participant 2, was updated to reflect the documentation of blood sugar checks as ordered on the history and physical dated 03/23/23 . All history / physicals and MARS will be reviewed/ audited, by 7/03/23, for identified areas of need.
Standard #:	22VAC40-61-410-A
Description:	Based on observations of the facility physical plant, the facility failed to maintain the interior of the building in good repair. EVIDENCE: 1. Ceiling stains were noted on the right side of the ceiling in the barber/beauty shop and in front of the window in the nursing office on the day of inspection.
Plan of Correction:	Kessler Roofing was called on 6/22/23 and scheduled to inspect the roof. Ceiling tiles in the barber/beauty shop and Nursing office were changed.