VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Eugene H. Bloom Retirement Center
308 Weaver Avenue
Emporia, VA 23847
(434) 348-4004

Current Inspector: Lanesha Allen (757) 715-1499

Inspection Date: Aug. 12, 2020 and Aug. 13, 2020

Complaint Related: No

Areas Reviewed:

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 BUILDING AND GROUNDS 22VAC40-73 EMERGENCY PREPAREDNESS 22VAC40-90 The Sworn Statement or Affirmation 22VAC40-90 The Criminal History Record Report

Comments:

This inspection was conducted by licensing staff using an alternate remote protocol necessary due to a state of emergency health pandemic declared by the Governor of Virginia. A renewal inspection was initiated on 8/7/2020 and concluded on 8/13/2020. The Administrator was contacted by telephone to initiate the inspection. The Administrator reported that the current census was 38. The inspector emailed the Administrator a list of items required to complete the inspection. The inspector reviewed 3 resident records, 3 staff records, staff schedules, Health Care Oversight, Fire Inspection Record, Health Department Inspection Record, Fire and Emergency drills, Oversight by dietitian or nutritionist, and Staff Sworn Disclosure Statements and Criminal Record Checks for new hires since last inspection. Information gathered during the inspection determined non-compliance(s) with applicable standards or law, and violations were documented on the violation notice issued to the facility.

Violations:

Standard #:	22VAC40-73-450-C
Description:	Based on record review and discussion, the facility failed to ensure the Individualized Service Plan (ISP) included the description of identified needs based upon the Uniform Assessment Instrument (UAI). Evidence: 1. Resident #2?s Uniform Assessment Instrument (UAI) dated 1/27/2020 stated mechanical and human help, physical assistance for mobility. 2. Resident #2?s Individual Service Plan (ISP) dated 1/27/2020 did not list the mechanical device needed for mobility. 3. Staff #1 acknowledged that Resident #2 sometime uses a cane for mobility.
Plan of Correction:	Facility will have LPN to recheck ISP to make ensure it has added all documentation needed each month on updated ISP and new ISP ,