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. 2, 2020 , Dec. 3, 2020 , Dec. 4, 2020 and Dec. 7, 2020

Complaint Related: No

Areas Reviewed:

22VAC40-61 PERSONNEL 22VAC40-61 SUPERVISION 22VAC40-61 ADMISSION, RETENTION, AND DISCHARGE 22VAC40-61 PROGRAMS AND SERVICES 22VAC40-61 EMERGENCY PREPAREDNESS 63.2 Protection of adults and reporting. 63.2(19.2) 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:

This inspection was conducted by licensing staff using an alternate remote protocol, necessary due to a state of emergency health pandemic declared by the Governor of Virginia. A monitoring inspection was initiated on 12-2-20 and concluded on 12-07-20. the director or in-charge person was contacted by telephone to initiate the inspection. There were five participants present and three staff. The inspector emailed the director/person in charge a list of items required to complete the inspection. The Inspector reviewed two participant's records and 2 staff records submitted by the facility to ensure documentation was complete. The information gathered during the inspection determined no violations with applicable standards or law. No violations were issued. The Licensing Inspector has reviewed with the director/person in charge COVID-19 guidance posted on the ADCC webpage.