VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Golden Homestead
120 Fourth Street
Coeburn, VA 24230
(276) 395-2808

Current Inspector: Crystal Mullins (276) 608-1067

Inspection Date: Oct. 17, 2024

Complaint Related: No

Areas Reviewed:

22VAC40-73 GENERAL PROVISIONS 22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES 22VAC40-73 PERSONNEL 22VAC40-73 STAFFING AND SUPERVISION 22VAC40-73 ADMISSION, RETENTION AND DISCHARGE OF RESIDENTS 22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-73 RESIDENT ACCOMMODATIONS AND RELATED PROVISIONS 22VAC40-73 BUILDINGS AND GROUND 22VAC40-73 EMERGENCY PREPAREDNESS

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: 10/17/2024 Begin: 10:00am End: 1:48pm The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. Number of residents present at the facility at the beginning of the inspection: 17 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 4 Number of staff records reviewed: 2 Number of interviews conducted with residents: 4 Number of interviews conducted with staff: 3 Observations by licensing inspector: 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 Crystal B. Henson, Licensing Inspector at 276-608-1067 or by email at crystal.b.mullins@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-380-A
Description:	Based on resident record review, the facility failed to include all required personal and social information on one resident. EVIDENCE: 1. Resident #1 was admitted to the facility on 06/27/2024. 2. The personal and social data information sheet for resident #1 had blanks for personal physician, personal dentist and other agency.
Plan of Correction:	Information has been updated. In the future, all personal and social data will be documented. Operations director will monitor. [sic]
Standard #:	22VAC40-73-750-B
Description:	Based on observations made during the tour of the building, the facility failed to include a sturdy chair for each resident in two of the resident bedrooms. EVIDENCE: 1. According to staff #2, there are two residents that reside in room #6 and room #2. Both rooms (#6 and #2) only had one chair available for the residents.
Plan of Correction:	A written specification shall be maintained in the resident record. In the future, any item require written specification will be maintained in the resident record. [sic]
Standard #:	22VAC40-73-870-A
Description:	Based on the tour of the facility, the facility failed to keep the interior and exterior of all buildings maintained in good repair. EVIDENCE: 1. A large piece of lattice on the back porch area of the building was found to be broken, missing, and in need of repair.
Plan of Correction:	Lattice will be repaired or replaced. In the future, all areas needing repair will be addressed. Administrator will monitor. [sic]
Standard #:	22VAC40-73-870-E
Description:	Based on observations made during the tour of the facility, the facility failed to ensure all furnishings, fixtures, and equipment, including furniture shall be kept clean and in good repair and condition. EVIDENCE: 1. In the common area beside the TV room there is a beige colored set, there was a six-eight-inch rip in the seat area of this chair. 2. In the hall area, outside of the common TV room and near the book case, a beige printed chair was found to have almost the entire area of the seat ripped.
Plan of Correction:	Chairs have been removed. In the future, all furnishings will be maintained in good repair. Administrator will monitor. [sic]
Standard #:	22VAC40-73-925-A
Description:	Based on the tour of the facility, the facility failed to have an adequate supply of hand soap accessible at each hand washing sink available to residents. EVIDENCE: 1. The common bathroom located across from the TV room was found to have no soap available for handwashing.
Plan of Correction:	Soap has been replaced. In the future, all handwashing sinks will have soap available. Supervisor shall monitor. [sic]