VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Greystone Manor
302 Greystone Drive
Castlewood, VA 24224
(276) 762-7929

Current Inspector: Crystal Mullins (276) 608-1067

Inspection Date: Oct. 18, 2023

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: Renewal Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 10/18/2023 Begin: 10:50am End:2:03pm 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: 19 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 5 Number of staff records reviewed: 2 Number of interviews conducted with residents: 2 Number of interviews conducted with staff: 2 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 #:	22VAC40-73-320-A
Description:	Based on review of resident records, the facility failed to include a description of the person?s reactions to any known allergies on the physical which must be completed 30 days preceding admission to an assisted living facility. EVIDENCE: 1. Resident #2 has a physical completed on 06/23/2022. The physical lists Ceclor capsules as an allergy. There are no reactions listed on the physical.
Plan of Correction:	Request reaction to Ceclor to be documented. In the future, review physical to ensure all reactions are document. [sic]
Standard #:	22VAC40-73-700-1
Description:	Based on review of resident records, the facility failed to have a valid physician?s order that includes the source of the oxygen such as compressed gas or concentrator. EVIDENCE: 1. Resident #2 has a physician?s order dated 08/28/2023 for Oxygen 2.5L, use 2.5L via nasal canula continuous. The source of the oxygen is not specified.
Plan of Correction:	Discuss need for source of oxygen to be added to the order with PCP. In the future, will ensure source of oxygen is included on the order. [sic]