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: Jan. 22, 2024

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: 01/22/2024 9:30am until 12:30pm Number of participants present at the facility at the beginning of the inspection: 20 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of participant records reviewed: 4 Number of staff records reviewed: 4 Number of interviews conducted with participants: 1 Number of interviews conducted with staff: 2 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 #:	22VAC40-61-260-C
Description:	Based on participant record review, the facility failed to ensure that annual physical examinations contained all required information. EVIDENCE: 1. The record for participant 4 has documentation of a physical examination that was completed on 11/21/2022. The record has documentation of progress notes that the participant was seen by his physician on 08/08/2023 and 12/27/2023. The progress note dated 12/27/2023 has an addendum that the participant is ambulatory and is capable of taking his own medications, which is required information on annual physical examinations. This addendum was not dated until 01/22/2024.
Plan of Correction:	Participant 4 has an MD appointment scheduled for their annual history and physical (H&P). Participant records will be reviewed / audited for identified needs on the annual H&P.
Standard #:	22VAC40-61-300-D
Description:	Based on participant record review and observations of the facility medication closet, the facility failed to ensure that a list of all medications taken by a participant was maintained. EVIDENCE: 1. The medication box for participant 1 contained an unopened bottle of Equate Pain Reliever Acetaminophen 500mg tablets. The physician signed medication list in the record for participant 1 and the January 2024 medication administration record for participant 1 did not contain documentation of this medication or any physician instructions for the administration of this medication.
Plan of Correction:	The unopened bottle of Equate Pain Reliever Acetaminophen 500mg tablets was immediately removed from the medication box and returned to the Responsible Party. A review of participant MAR?s was performed on 1/23/24 to ensure all medications have a current / accurate physician order. Participant MAR?s will be reviewed for accuracy on a monthly basis as well as any updated Histor and Physical form.
Standard #:	22VAC40-61-550-C
Description:	Based on physical plant observation and staff interview, the center failed to ensure the first aid kit?s contents shall be replaced before expiration dates and as necessary. EVIDENCE: 1. During an on-site inspection on 1/22/2024, the Purell Advanced Hand Sanitizer located in the first aid kit had an expiration date of 8/2023. 2. During an on -site inspection on 1/22/2024, the flashlight in the first aid kit was noted to be inoperable and the extra batteries located in the first aid kid were the incorrect size for the flashlight. Staff person 4 indicated that the flashlight would not operate even when the correct size batteries were located and placed in in the flash light.
Plan of Correction:	The expired Purell Advanced Hand Sanitazer, mixed in with valid dated Hand Sanitizer, was immediately removed from the first aid kit. The inoperable flashlight was immediately replaced with a operating flashlight and a set of the correct size replacement batteries. An inventory checklist with expiration dates, to include verifying the flashlight is in working order, will be implemented and checked monthly.