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: Nov. 29, 2021

Complaint Related: No

Areas Reviewed:

22VAC40-61 ADMINISTRATION 22VAC40-61 PERSONNEL 22VAC40-61 SUPERVISION 22VAC40-61 ADMISSION, RETENTION, AND DISCHARGE 22VAC40-61 PROGRAMS AND SERVICES 22VAC40-61 BUILDINGS AND GROUNDS 22VAC40-61 EMERGENCY PREPAREDNESS

Comments:

An unannounced renewal inspection was conducted on 11-29-21 (arrival 8:55 am /departure 11:20 am). There were 2 participants in care and 2 staff and the director present when the inspectors arrived. During the inspection 1 additional participant arrived. An exercise activity was observed, tour of the facility and exterior grounds were conducted. Three participant and 3 staff records were reviewed. Interviews were conducted with staff and participants. All of the required postings such as participant rights, license, menu, and activity calendar were observed. The water temperature was taken and found to be within the acceptable range. An exit interview was conducted with the director. Please complete the columns for "Plan of Correction" and "Date To Be Corrected" for each violation cited on the Violation Notice, and then return a signed and dated copy to the licensing office within 10 calendar days of receipt. If you have any questions, contact your licensing inspector at (757)670-0504.

Violations:

Standard #:	22VAC40-61-180-E-2
Description:	Based on document review and provider interview, the facility failed to ensure that annual tuberculosis (TB) evaluations were obtained. EVIDENCE: During review of staff records, staff #1 and staff #3 did not have recent TB test on file. The most recent TB test for staff #1 was dated 10/22/20 and the most recent TB test for staff #3 was dated 10/12/20.
Plan of Correction:	Staff #1 and Staff #3 TB test have been updated. Staff #1's TB was completed on 11/29/21 and Staff #3's TB test was completed on 10/12/21.