VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Ascend Health Adult Retreat
6421 Chesterfield Meadows Drive
Chesterfield, VA 23832
(804) 641-0952

Current Inspector: Kimberly Davis (804) 662-7578

Inspection Date: Aug. 10, 2022

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 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: Renewal Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 8-10-22 from 10:15 a.m.-12:50 p.m. 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: 8 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: 3 Number of interviews conducted with staff: 1 Additional Comments/Discussion: Facility documentation, facility postings, and the first aid kit were also reviewed. Participants were engaged in activities and the lunch meal was observed. 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 Kimberly Davis, Licensing Inspector at (804) 662-7578 or by email at Kimberly.M.Davis@dss.virginia.gov

Violations:

Standard #:	22VAC40-61-50-E
Description:	Based on a review of participant records the center failed to ensure that the rights and responsibilities of participants shall be reviewed annually with each participant, or if a participant is unable to fully understand and exercise his rights and responsibilities, the annual review shall include his family member or his legal representative. Evidence of this review shall include the date of the review and the signature of the participant, family member, or legal representative and shall be included in the participant?s file. Evidence: -The record for Participant # 3 (admit date: 5-17-21) contained an annual review of participant rights and responsibilities last dated 6-30-21. -The record for Participant # 4 (admit date:5-10-21) contained an annual review of participant rights and responsibilities last dated 6-11-21.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-61-230-D
Description:	Based on a review of participant records the center failed to ensure that the participant plan of care contained a description of all identified needs. Evidence: -The plan of care (dated: 4-28-22) for Participant # 2 (admit date: 5-2-22) identified the following needs: memory recall, cognitive stimulation, physical stimulation, transportation, and nutrition. However, Participant # 2?s participant assessment (dated 4-25-22) documented that the resident needs help with the following activities that were not addressed on the plan of care: climbing stairs, bathing, dressing, toileting, and bowel and bladder continence. -The plan of care (dated 4-29-22) for Participant # 3 (admit date: 5-17-21) identified the following needs: transportation, toileting, eating, bladder/bowel, memory recall, and physical activity. However, Participant # 3?s participant assessment (dated:4-29-22) noted that the resident needs help with the following activities that were not addressed on the plan of care: bathing, dressing, transferring, and feeding.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-61-260-B
Description:	Based on a review of participant records the center failed to ensure that the report of the required physical examination contained all required items. Evidence: -The record for Participant # 3 (admit date: 5-17-21) contained a medical documentation form dated 7-16-21 from the Veterans Health Administration that did not include the following required information for a physical examination and report: height, weight, blood pressure, any special diet or any food intolerances, and did not contain an evaluation for tuberculosis (TB). -The record for Participant # 4 (admit date: 5-10-21) contained a history and physical from the Department of Veterans Affairs dated 3-21-22 that did not include the following required information: height, any known allergies and descriptions of reactions, any special diet or any food intolerances, and did not contain an evaluation for tuberculosis (TB).
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-61-260-C
Description:	Based on a review of resident records the facility failed to ensure that each participant shall annually submit a report of physical examination by a physician. Evidence: -The record for Participant # 3 (admit date: 5-17-21) contained a medical documentation form dated from the Veterans Health Administration last dated 7-16-21.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-61-550-C
Description:	Based on a review of the center?s first aid kit, the center failed to ensure that the first aid kit shall be checked at least annually. Evidence: The center?s First Aid Checklist documented that the first aid kit was last reviewed in January 2019. Staff # 4 stated that the first aid kit had been recently reviewed but not documented.
Plan of Correction:	Not available online. Contact Inspector for more information.