VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Gloucester Adult Day Break
5873 Fiddlers Green Road
Gloucester, VA 23061
(804) 695-9008

Current Inspector: Alyshia E Walker (757) 670-0504

Inspection Date: Dec. 10, 2019

Complaint Related: No

Areas Reviewed:

22VAC40-60 ADMINISTRATION 22VAC40-60 PERSONNEL. 22VAC40-60 SUPERVISION. 22VAC40-60 BUILDINGS AND GROUNDS. 22VAC40-60 ADMISSION, RETENTION AND DISCHARGE. 22VAC40-60 PROGRAMS AND SERVICES. 22VAC40-60 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:

An unannounced monitoring inspection was conducted on 12-10-19 (ar 08:40 am/dep 11:18pm). The facility census was 4. The facility is currently licensed for 24. The director was present for the entrance interview and the exit interview. Two staff were present; the first aid kit was review, staff and participants records, water temperature, a tour of the facility and check of medications. No one medication pass observed, the morning activities were observed and the breakfast meal observed. Comments: The LI and director discussed the upcoming ADCC training and new regulations and information posted on the public website. Also the facility documented notification to the fire marshal regarding the fire inspection.. The acknowledgement document was signed and dated by the director during the exit interview.