VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Humphrey's Retirement Home
3405 Chamberlayne Avenue
Richmond, VA 23227
(804) 329-1316

Current Inspector: Shelby Haskins (804) 305-4876

Inspection Date: Nov. 4, 2019

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 ACCOMODATIONS AND RELATED PROVISIONS 22VAC40-73 BUILDING AND GROUNDS 22VAC40-73 EMERGENCY PREPAREDNESS 22VAC40-80 THE LICENSE.

Comments:

On 10/01/2019 the assigned licensing inspector and the Licensing Administrator for the Central region were on site to conduct an unannounced renewal inspection. Also present during the renewal inspection was a VDSS home office representative. The facility Administrator was not on site upon the arrival of the VDSS representatives but arrived shortly thereafter. The staff person on site was made aware of the purpose of the inspection. Upon the arrival of the Administrator the VDSS representatives discussed the purpose of the inspection and reviewed the physical plant noncompliance observed thus far. The VDSS representatives along with the facility Administrator conducted a walk through of the first floor physical plant of the building. Residents, staff and other facility records were reviewed for compliance. Due to the repairs being made to the second floor of the building, follow up on previously cited non compliance could not be determined. The Administrator was informed that the renewal inspection to review compliance for the second floor of the building and other protocols for renewal would be conducted at a later date. The inspection on 10/01/2019 was conducted between the approximate hours of 9:30 and 12:00p.m. On 10/21/2019 the licensing inspector resumed the renewal inspection. A morning medication administration pass was observed. Residents were in the process of leaving the facility for various day programs others were preparing for breakfast. Workers were still on site making repairs to previously cited noncompliance. Based on the outcome of the two day inspection repeat violations have been cited and is contained within this report. The facility Administrator accepted assistance from the inspector to develop a plan of correction.Please complete the 'plan of correction' and 'date to be corrected' for each violation cited on the violation notice and returned it to me within 10 calendar days from today. You will need to specify how the deficient practice will be or has been corrected. Just writing the word 'corrected' is not acceptable. Your plan of correction must contain: 1) steps to correct the noncompliance with the standard(s), 2) measures to prevent the noncompliance from occurring again; and 3) person(s) responsible for implementing each step and/or monitoring any preventive measure(s). If you have any questions please feel free to contact me at (804)662-9774 or by e-mail at Angela.r.reaves@dss.virginia.gov if you have any questions. The inspection was conducted on 10/21/2019 was conducted between the approximate hours of 7:15 and 8:30a.m.

Violations:

Standard #:	22VAC40-73-210-C
Description:	Based on the review of facility records and interviews conducted with the facility Administrator on 10/01/2019, the facility failed to ensure that all direct care staff training for the first year commenced no later than 60 days after employment. Evidence: Staff #1- Documented date of hire 07/26/2019 The facility did not submit for the inspectors review documented evidence that annual staff development training hours had begun for this staff member.
Plan of Correction:	FACILITY RESPONSE-" Administrator will inspect all files to ensure that they are updated and annual training is done in the time alloted."
Standard #:	22VAC40-73-260-A
Description:	Based on the review of facility records and interviews conducted with the facility Administrator on 10/01/2019, the facility failed to ensure that all direct care staff received certification in First Aid. Evidence: Staff #2- Documented date of hire=01/15/2016- First Aid expired 03/2018. Staff #3-Documented date of hire=04/17/2019- First Aid expired 06/2018 Upon request the facility did not submit for the inspectors review documented evidence that staff #s 2 and 3 were certified in First Aid.
Plan of Correction:	FACILITY RESPONSE-" Administrator will inspect all files and make sure First Aid and CPR certificates are in employees file."
Standard #:	22VAC40-73-260-B
Description:	Based on the review of facility records and interviews conducted with the facility Administrator on 10/01/2019, the facility failed to ensure that all direct care staff received certification in Cardiopulmonary resuscitation (CPR) Evidence: Staff #2- Documented date of hire=01/15/2016- CPR expired 03/2018. Staff #3-Documented date of hire=04/17/2019- CPR expired 06/2018 Upon request the facility did not submit for the inspectors review documented evidence that staff #s 2 and 3 were certified in CPR.
Plan of Correction:	FACILITY RESPONSE-"Administrator will inspect files and make sure First aid + CPR certificates are in files."
Standard #:	22VAC40-73-510-B
Description:	Based on the interview conducted with the facility Administrator on 10/01/2019, the facility failed to ensure that written procedures to ensure communication and coordination between the assisted living facility and the mental health service provider was established. Evidence: Upon request the facility Administrator did not submit for the inspectors review documented evidence that she had developed written procedures to ensure the coordination of services with the resident's mental health service providers
Plan of Correction:	FACILITY RESPONSE-" Written procedures will be developed to ensure communication and coordination between the assisted living facility and mental health service providers."
Standard #:	22VAC40-73-520-H
Description:	Based on observation and interviews conducted with the facility Administrator on 10/01/2019 the facility did not have the current month's schedule shall be posted in a conspicuous location in the facility or otherwise be made available to residents and their families. Evidence Upon request the facility did not submit for the inspectors review documented evidence that an October 2019 activity schedule was made available to residents and their families. The inspector did not observe the posting of the October 2019 activity schedule
Plan of Correction:	FACILITY RESPONSE-"Activities and menus will be on the Board for the review of residents and their families."
Standard #:	22VAC40-73-610-B
Description:	Based on observation and interview conducted with the facility Administrator on 10/01/2019, the facility failed to ensure that the menus for meals and snacks for the current week was dated and posted in an area conspicuous to residents. Evidence: Upon request the facility did not submit for the inspectors review documented evidence that a menu for the week of 10/01/2019- 10/05/2019 was posted.
Plan of Correction:	FACILITY RESPONSE-"
Standard #:	22VAC40-73-750-E
Description:	Based on observation of the facility on 10/01/2019 with the facility Administrator, the facility failed to have sufficient bed and bath linens in good repair so that residents always have clean mattress covers when needed. Evidence: As evidenced by the photographs taken the following was observed: ? The bed linen in bedroom #s 2 and 4 was observed to have a yellow stain and contained debris. ? The mattresses was observed to be sunken-in.
Plan of Correction:	FACILITY RESPONSE- " Humphrey Home use Services of Virginia Linen. Adm and staff will make sure that products have no stains, or debris. Humphrey Home will continiously inspect mattress and buy mattresses when needed."
Standard #:	22VAC40-73-860-D
Description:	Based on observation of the facility on 10/01/2019 with the facility Administrator, the facility failed to ensure that any operable window (i.e., a window that may be opened) was effectively screened. Evidence: As evidenced by the photographs taken on 10/01/2019, the following was observed: ? Both resident bathroom windows on the first floor did not have a screen in the windows.
Plan of Correction:	FACILITY RESPONSE-"Screens will be replaced in the windows."
Standard #:	22VAC40-73-860-I
Description:	Based on observation of the interior physical plant of the facility on 10/01/2019 with the facility Administrator the facility failed to ensure that cleaning supplies and other hazardous materials were stored in a locked area. Evidence: As evidenced by the photographs taken the inspector observed the following: ? A first floor janitorial closet that contained chemicals, cleaning chemicals and other hazardous items was unlocked. ? Unattended chemicals in two large containers, a paint scraper, garden tools, a large yellow electrical cord, and two cans of paint were being stored in the hall way exit door and facility hall way near the Administrator?s office.
Plan of Correction:	FACILITY RESPONSE-" Linen and janitorial closets will be locked. Unattended chemicals will be put in their proper locations after use."
Standard #:	22VAC40-73-870-E
Description:	Based on observation of the facility on 10/01/2019 with the facility Administrator, the facility failed to ensure that all furnishings, fixtures, and equipment, including furniture, window coverings, sinks, toilets, bathtubs, and showers, was kept clean and in good repair and condition. Evidence: As evidenced by the photographs taken the inspector observed the following: -A thermostat was detached from a wall in the dining room. -The basin in the first floor bathroom across from bedroom # 5 -A light fixture on the wall leading to the second floor was broken and without a light bulb. -The basin in the bathroom on the first floor across from bedroom #5 was observed to have debris and was unclean.
Plan of Correction:	FACILITY RESPONSE-"Thermostat will be replaced and secured to the wall. Light fixture is operable andflash bulb will be replaced. All bathrooms will be inspected for cleanliness."
Standard #:	22VAC40-73-925-A
Description:	Based on observation of the physical plant of the facility on 10/01/2019 with the facility Administrator, the facility failed to ensure that all bathrooms had an adequate supply of toilet tissue and soap. Evidence:The bathrooms on the first floor of the facility did not have toilet tissue, paper towels and hand soap available to the residents.
Plan of Correction:	FACILITY RESPONSE-"All bathrooms will have toilet tissue, paper towels and hand soap available to the resident."
Standard #:	22VAC40-80-120-E-2
Description:	Based on observation of the physical plant of the facility on 10/01/2019 the facility failed to post the findings of the most recent inspection conducted at the facility. Evidence: The inspector did not obs eve that the most recent inspection report was posted in the facility. Upon the arrival of the Administrator, the inspector inquired abut the posting and the facility Administrator stated that the inspection report was not posted.
Plan of Correction:	FACILITY RESPONSE-"