VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Clean Hands Pure Hearts Adult Day Center LLC
1421 Kempsville Road
Chesapeake, VA 23320
(757) 819-6774

Current Inspector: Donesia Peoples (757) 353-0430

Inspection Date: Sept. 16, 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 22VAC40-90 BACKGROUND CHECKS FOR ASSISTED LIVING FACILITIES 22VAC40-90 THE SWORN STATEMENT OR AFFIRMATION 22VAC40-90 THE CRIMINAL HISTORY RECORD REPORT

Technical Assistance:

Participant Rights 22VAC40-61-50-D Participant Plan of Care 22VAC40-61-230-D Participant Sign in Log 22VAC40-61-190-C Assessment procedures 22VAC40-61-220-D Participant agreement with the Center 22VAC40-61-240

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: An unannounced monitoring inspection took place on 9/16/2024 at 9:40 am to 11:18 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: 2 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: 3 Number of interviews conducted with participants: 2 Number of interviews conducted with staff: 1 Observations by licensing inspector: An observation of an activity was conducted during the inspection. Additional Comments/Discussion: None 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 Donesia Peoples, Licensing Inspector at 757-353-0430 or by email at donesia.peoples@dss.virginia.gov

Violations:

Standard #:	22VAC40-61-180-E-1
Description:	Based on the record review and staff interview the center failed to ensure each staff person and volunteer identified in this subsection shall obtain an evaluation provided 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 record for staff # 1, hire date of 7/01/24, did not contain an assessment for TB. 2. The record for volunteer #3, hire date of 8/26/24, did not contain an assessment for TB. 3. Staff #1 confirmed the records for staff #1 and volunteer #3 did not contain an assessment for TB.
Plan of Correction:	All staff and volunteers will obtain a TB assessment.
Standard #:	22VAC40-61-230-A
Description:	Based on the 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 shall be developed for each participant. The plan shall be reviewed and updated, if necessary, within 30 days of admission. Evidence: 1. The record for participant #1, admission date of 8/19/24, does not contain a plan of care completed prior to or on the day of admission. The participant?s plan of care is dated as completed on 9/02/24.
Plan of Correction:	Plan of cares will be done on the day of admission.
Standard #:	22VAC40-61-260-A
Description:	Based on the record review and staff interview the center failed to ensure within the 30 days preceding admission, a participant shall have a physical examination by a licensed physician. Evidence: 1. The record for participant #1, admission date of 8/19/24, did not contain a physical examination. 2. The record for participant #2, admission date of 9/03/24, did not contain a physical examination. 3. Staff #1 confirmed the records for participant #1 and participant #2 did not contain a physical examination.
Plan of Correction:	Physical forms have been saved in files.
Standard #:	22VAC40-61-260-B
Description:	Based on the record review and staff interview the center failed to ensure the participant 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 admission. Evidence: 1. The record for participant #1, admission date of 8/19/24, did not contain an assessment for TB. 2. The record for participant #2, admission date of 9/03/24, did not contain an assessment for TB. 3. Staff #1 confirmed the records for participant #1 and participant #2 did not contain an assessment for TB.
Plan of Correction:	TN test results have been saved in files.