VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Raspberry Hill Adult Daytime Center
1381 Crossings Centre Dr., Suite A
Forest, VA 24551
(434) 525-4422

Current Inspector: Cynthia Jo Ball (540) 309-2968

Inspection Date: June 23, 2023

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: Renewal Date of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 06/23/2023 10:00am until 1:30pm 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: 14 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of participant records reviewed: 3 Number of staff records reviewed: 3 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 #:	22VAC40-61-230-D
Description:	Based on review of participant records, the facility failed to ensure that identified needs were identified on participant plan of cares (POC). EVIDENCE: 1. The record for participant 1 has a physical examination dated 06/02/2023 that has documentation that the participant is a Do Not Resuscitate (DNR) and has been prescribed a no added salt diet. The assessment dated 06/16/2023 in the record for participant 1 has that the participant requires assistance with eating/feeding and bladder continence. The POC dated 06/06/2023 in the record for participant 1 does not address these identified needs. 2. The assessment dated 04/04/2023 in the record for participant 3 has documentation that the participant uses a walker. The POC dated 04/07/2023 in participant 3?s record does not address this identified need.
Plan of Correction:	Participant?s #1 copy of DNR has been obtained and placed in their file. POC has been updated and signed and filed to address the needs of feeding, eating, and bladder continence. POC has been updated to reflect the use of a walker and a copy has been signed and filed.
Standard #:	22VAC40-61-260-C
Description:	Based on review of participant records, the facility failed to ensure that a physical examination was completed annually for all participants. EVIDENCE: 1. The most recent physical examination in the record for participant 2 was dated 04/06/2022.
Plan of Correction:	Physical Examination forms have been given to caregiver and explained a physical has to be done immediately in order to attend Center.
Standard #:	22VAC40-61-300-E-1
Description:	Based on observations of the facility medication cart, the facility failed to ensure that all medications remained in the original container with the prescription label or direction label attached and legible. EVIDENCE: 1. A Wixela Inhaler and two Spirivia Respimat Inhalers were noted to be in the cart with the name for Participant 4 labeled on them. The medications were not in the original container and did not contain the pharmacy label on the day of inspection. 2. A Novolog Flexpen was noted in the cart with the name for participant 3 labeled on it. The Flexpen did not contain the pharmacy label on the day of inspection.
Plan of Correction:	Contact the Caregiver of both Participants to obtain the original medication containers.