VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Angel's Adult Daycare Center LLC
430 North Main Street
Suffolk, VA 23434
(757) 334-0474

Current Inspector: Margaret T Pittman (757) 641-0984

Inspection Date: May 13, 2022 and May 13, 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 22VAC40-90 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: 05/03/2022 from 9:21 am to 9:25 am and 05/13/2022 from 8:56 am to 10:35 am. 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: 0 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of participant records reviewed: 1 Number of staff records reviewed: 2 Observations by licensing inspector: Required postings and first aid kit reviewed. 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 M. Tess Pittman, Licensing Inspector at (757) 641-0984 or by email at tess.pittman@dss.virginia.gov.

Violations:

Standard #:	22VAC40-61-70
Description:	Based on record review, the center failed to maintain public liability insurance for bodily injury with a minimum limit of at least $1 million for each occurrence or $1 million aggregate. Evidence of insurance coverage shall be made available to the department's representative upon request. Evidence: 1. Staff #1 was unable to provide evidence of insurance coverage during the onsite inspection on 05-13-2022.
Plan of Correction:	Staff #1 provided evidence of insurance coverage showing that Angel?s Adult Daycare Center LLC maintains public liability insurance for bodily injury with a minimum limit of at least $1 million for each occurrence or $1 million aggregate.
Standard #:	22VAC40-61-160-A-1
Description:	Based on record review, the center failed ensure each direct care staff member maintain current certification in first aid from the American Red Cross, American Heart Association, National Safety Council, American Safety and Health Institute, community college, hospital, volunteer rescue squad, or fire department. Evidence: 1. Staff #5?s is direct care staff and was hired 12-29-2021; however, Staff #5 does not have a current certification in first aid.
Plan of Correction:	Provided evidence that Staff #5 now has a current certification in first Aid from the American Heart Association.
Standard #:	22VAC40-61-220-C
Description:	Based on record review, the center failed to ensure the assessment identify the person's abilities and needs to determine if and how the program can serve the participant. Evidence: 1. The assessment for Participant #1 (dated 05-04-2022) identifies the participant needs assistance with bathing, dressing, and transferring; however, it does not describe what kind of help the participant needs. The assessment is also not signed by the assessor of the assessment.
Plan of Correction:	The assessment for Partipant#1 was corrected with the kind of help that the participant will need and signed.
Standard #:	22VAC40-61-230-A
Description:	Based on record review, the center failed to ensure prior to or on the date of admission, a preliminary multidisciplinary plan of care based upon the assessment be developed for each participant. Evidence: 1. Participant #1 (admitted 05-05-2022) did not have a preliminary multidisciplinary plan of care in their participant file.
Plan of Correction:	Updated participant #1multidisciplinary plan of care in the participant file.
Standard #:	22VAC40-61-260-A
Description:	Based on record review, the center failed to ensure within the 30 days preceding admission, a participant have a physical examination by a licensed physician. Evidence: 1. Participant #1 (admitted 05-05-2022) did not have a physical examination to include an assessment for tuberculosis by a licensed physician in their participant file.
Plan of Correction:	Validated that Participant #1has a physical examination to include an assessment for tuberculosis by his primary care physician.
Standard #:	22VAC40-61-410-A
Description:	Based on observation, the center failed to ensure the interior and exterior of all buildings be maintained in good repair, kept clean and free of rubbish, and free from safety hazards. Evidence: 1. During a tour of the center, a window was observed to be cracked. An electrical box on the outside of the center was also observed to have exposed wires.
Plan of Correction:	Repaired cracked window and electrical box on the outside of the center.
Standard #:	22VAC40-61-510-A
Description:	Based on record review, the center failed to comply with the Virginia Statewide Fire Prevention Code (13VAC5-51) as determined by at least an annual inspection by the appropriate fire official. Evidence: 1. The last inspection by the appropriate fire official was completed on 03-01-2021.
Plan of Correction:	The City of Suffolk Fire Inspector conducted the required Annual Fire Inspection.
Standard #:	22VAC40-90-40-B
Description:	Based on record review, the center failed to obtain a criminal history record report on or prior to the 30th day of employment for each employee. Evidence: 1. The center did not obtain a completed criminal history record report on or prior to the 30th day of employment for the following staff: Staff #3, Staff #4, and Staff #5. 2. The center has not obtained a completed criminal history record report on Staff #2.
Plan of Correction:	The center has resubmitted to obtain a completed criminal history record report on Staff #2.