VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Heavn On Earth Adult Day Center
3847 A South Crater Road
Petersburg, VA 23805
(804) 766-1110

Current Inspector: Shelby Haskins (804) 305-4876

Inspection Date: Nov. 17, 2023

Complaint Related: No

Areas Reviewed:

22VAC40-61 GENERAL PROVISIONS 22VAC40-61 BUILDINGS AND GROUND 22VAC40-61 EMERGENCY PREPAREDNESS

Technical Assistance:

Participant to restroom ratio First Aid Kit item

Comments:

Type of inspection: Initial Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 11/17/2023, 10:08 a.m. ? 12:00 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: 0 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of staff records reviewed: 2 An exit meeting will be conducted to review the inspection findings. The evidence gathered during the initial inspection determined non-compliance with applicable standard(s) or law, and violation(s) were documented on the violation notice issued to the facility. The applicant has the opportunity to submit a plan of correction to indicate how the cited violation(s) will be addressed in order to maintain future compliance with applicable standard(s) or law. If the applicant 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 should the facility be issued a license to operate. 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 a licensed facility. For more information about the VDSS Licensing Programs, please visit: www.dss.virginia.gov Should you have any questions, please contact Alex Poulter, Licensing Inspector at (804)662-9771 or by email at alex.poulter@dss.virginia.gov

Violations:

Standard #:	22VAC40-61-50-D
Description:	Based on observation, the center failed to post the name and telephone number of the appropriate licensing administrator of the department; the Adult Protective Services toll-free telephone number; the toll-free telephone number of the Virginia Long-Term Care Ombudsman Program and any local ombudsman program servicing the area; and the toll-free telephone number of the disAbility Law Center of Virginia. Evidence: On 11-17-2023, Licensing staff observed the required Participants Rights were not posted, as the posted rights did not contain all of the required elements. Photographic evidence was obtained.
Plan of Correction:	Drawings were posted onsite of inspections, all necessary drawings were drawn and placed on the plan.
Standard #:	22VAC40-61-50-D
Description:	Based on observation, the center failed to post the name and telephone number of the appropriate licensing administrator of the department; the Adult Protective Services toll-free telephone number; the toll-free telephone number of the Virginia Long-Term Care Ombudsman Program and any local ombudsman program servicing the area; and the toll-free telephone number of the disAbility Law Center of Virginia. Evidence: On 11-17-2023, Licensing staff observed the required Participants Rights were not posted, as the posted rights did not contain all of the required elements. Photographic evidence was obtained.
Plan of Correction:	Posting of participants rights were posted at the time of inspection.
Standard #:	22VAC40-61-460-H
Description:	Based on observation, the facility failed to ensure hot water at taps was maintained within a temperature range of 105?F to 120?F. Evidence: The water temperature obtained on 11-27-2023 in the participant bathroom sink was measured at 190?F. Center staff was present and observed the temperature was outside of the required range at taps.
Plan of Correction:	Hot water heater will be turned down to correct temperature.
Standard #:	22VAC40-61-530-B
Description:	Based on observation, the facility failed to ensure the fire and emergency evacuation drawing documented primary and secondary exits, telephones, fire boxes, assembly and refuge areas. Evidence: During onsite inspection on 11-17-2023, the center did not have the evacuation plan posted, and the plan did not include required elements such as primary and secondary exits, telephones, fire boxes, assembly and refuge areas
Plan of Correction:	Not available online. Contact Inspector for more information.