VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Heavenly Hands Adult Day Inc.
529 East Mercury Boulevard
Hampton, VA 23663
(757) 725-0919

Current Inspector: Alyshia E Walker (757) 670-0504

Inspection Date: Jan. 19, 2024

Complaint Related: No

Areas Reviewed:

22VAC40-61 GENERAL PROVISIONS 22VAC40-61 ADMINISTRATION 22VAC40-61 PERSONNEL 22VAC40-61 SUPERVISION 22VAC40-61 PROGRAMS AND SERVICES 22VAC40-61 BUILDINGS AND GROUND 22VAC40-61 EMERGENCY PREPAREDNESS 22VAC40-80 THE LICENSE 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: 1/19/24 10:00 am- 11:51 pm 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: The center does not currently have any participants. The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of participant records reviewed:0 Number of staff records reviewed: 3 Number of interviews conducted with participants: 0 Number of interviews conducted with staff: 1 Observations by licensing inspector: Licensing Inspector conducted a physical plant inspection of the center. 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 Alyshia Walker, Licensing Inspector at 757-670-0504 or by email at Alyshia,Walker@dss.virginia.gov

Violations:

Standard #:	22VAC40-61-50-D
Description:	Based on observation, the center failed to ensure the posting of the name and telephone number of the appropriate regional licensing administrator of the department. Evidence: On 1/19/24, during an inspection of the center, the Participant Rights posting did not contain the name and telephone number of the appropriate regional licensing administrator of the department.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-61-160-A-1
Description:	Based on record review, the center failed to ensure each direct care staff member maintained 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. The staff records for Staff #1 and #3 did not contain evidence the staff members had current certification in first aid. 2. The staff record for Staff #2 contained first aid certification however, the certification was not obtained from one of the approved first aid providers listed in the Standard.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-61-180-D
Description:	Based on staff file reviewed, the facility failed to document the date of hire for staff. Evidence: 1. The staff record for Staff #3 did not contain the date of hire. 2. Staff #1 acknowledged the application was blank for hire date for Staff #3.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-61-180-E-1
Description:	Based on record review and interview, the center failed to ensure that each staff person shall obtain an evaluation by a qualified licensed practitioner that completes an assessment for tuberculosis (TB) in a communicable form no earlier than 30 days before or no later than seven days after employment or contact with participants. Evidence: 1. The staff records for Staff members #1, #2, and #3 did not contain TB assessments. 2. Staff #1 acknowledged the staff records did not contain TB assessments.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-80-120-E-2
Description:	Based on observation, the center failed to post the findings of the most recent inspection of the facility. Evidence: 1. During an inspection of the center on 1/19/24, the findings of the most recent inspection of the center were not observed to be posted. 2. Staff #1 acknowledged the findings of the most recent inspection were not posted.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-90-30-B
Description:	Based on record review, the facility failed to ensure a sworn statement or affirmation be completed for all applicants for employment. Evidence: 1. The signed Sworn Disclosures for Staff #1 and Staff #3 were incomplete as the documents only contained signatures and dates. Questions 1, 2, 3, and 4 were not answered. 2. There was no Sworn Disclosure for Staff #2.
Plan of Correction:	Not available online. Contact Inspector for more information.
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 criminal record for Staff #1 was dated 2/24/2016. 2. The staff record for Staff #2 (D.O.H. 2/1/22) did not contain a completed criminal history record report.
Plan of Correction:	Not available online. Contact Inspector for more information.