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: Oct. 11, 2024

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 63.2 GENERAL PROVISIONS 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: 10/11/2024 11:00am to 2:00pm 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: 2 Number of staff records reviewed: 2 Number of interviews conducted with staff: 2 Observations by licensing inspector: The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Licensing Inspector toured the building and physical grounds of the facility. The inspector observed that the building was in good condition as well as the outside grounds to include a participant garden as well as an enclosed area for participant drop off/pick up for arrival and departure to the center. The kitchen and restroom areas clean and appeared to be up to standards. Additional Comments/Discussion: 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 Shelby Hopkins, Licensing Inspector at (804) 305-4876 or by email at Shelby.haskins@dss.virginia.gov.

Violations:

Standard #:	22VAC40-61-220-E
Description:	Based on the review of participant records, the center did not ensure that an updated, current Uniform Assessment Instrument (UAI) was completed for the participant. Evidence: 1. Participant #2 file did not include a current Uniform Assessment Instrument (UAI). There was not a UAI in the file of participant #2. 4. Staff #1 was given the opportunity to look for the Uniform Assessment Instrument (UAI). Staff #1 was not able to locate the Uniform Assessment Instrument in the file of Participant #2.
Plan of Correction:	The Director or Designated Representative will ensure that all Uniform Assessment Instruments (UAI) are current and updated in each participant file.
Standard #:	22VAC40-61-260-A
Description:	Based on the review of participant records, the center did not ensure that the required initial physical examination was on file at the center within 30-day window of admission to the center. Evidence: 1. Participant #1 file did not include an initial physical upon admission on 01/08/2024. 2. Staff #1 was given the opportunity to look for the initial physical examination for Participant #1 and Staff #1 was unable to locate it.
Plan of Correction:	The Director or Designated representative will ensure that the participants physical examination and TB screening is completed at least 30 days prior to admission.