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: Dec. 1, 2022 and Dec. 20, 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: Monitoring Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 12/01/2022 at 8:40 am and 12/20/2022 from 10:00 am to 11:00 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 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 #:	22VAC40-61-190-A
Description:	Based on observation, the center failed to have one staff person on the premises in charge of the administration of the center during the center?s hours of operation. Evidence: 1. On 12/01/2022 around 8:30 am, the center was closed with no one present during its operating hours of 8:30 am to 3:30 pm. The unannounced inspection was unable to be conducted.
Plan of Correction:	Angel's Adult Daycare Center LLC will notify the license inspector if the Center will be closed.
Standard #:	22VAC40-61-220-E
Description:	Based on record review, the center failed to ensure a written assessment of a participant be reviewed and updated at least every six months. Evidence: 1. The last assessment for Participant #1 was completed on 05/04/2022.
Plan of Correction:	On 12/21/2022, Participant #1 assessment was completed.
Standard #:	22VAC40-61-230-F
Description:	Based on record review, the center failed to ensure any updates to a participant?s plan of care be signed and dated by the staff person who completed the plan and the participant, family member, or legal representative. Evidence: 1. The plan of care for Participant #1 was updated on 11/04/2022; however, there is no signature indicating the staff member who completed the plan or the participant/family member?s review of the updated plan.
Plan of Correction:	On 12/21/2022, Participant #1 signed and dated and put in his record.