VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Good Neighbor Village Inc.
8825 Buffin Road
Richmond, VA 23231
(804) 795-9813

Current Inspector: Angela Rodgers-Reaves (804) 662-9774

Inspection Date: June 9, 2022

Complaint Related: No

Comments:

On 06/09/2022 between the approximate times of 10:38A.M until 12:21P.M the licensing inspectors were on-site at the facility to conduct a monitoring inspection. 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. 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. 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 Angela Rodgers-Reaves, Licensing Inspector at (804) 840-0253 or by email at angela.r.reaves@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-100-A
Description:	Based on observation and interview with staff, the assisted living facility failed to implement an infection control program addressing the surveillance, prevention, and control of disease and infection that is consistent with the federal Centers for Disease Control and Prevention (CDC) guidelines and the federal Occupational Safety and Health Administration (OSHA) blood borne pathogens regulations. Evidence: Upon entry to the facility the inspector?s observed that facility staff #s 1, 2 and 3 did not have on a mask or face covering.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-210-G
Description:	Based on the review of facility records and interviews conducted the facility failed to ensure that documentation of the entity that provided the training, number of hours of training is kept by the facility in a manner that allows for identification by individual staff person and is considered part of the staff member's record. Evidence: The facility?s training log document that was submitted for the inspector?s review on 06/09/2022 is not documented to note the specific hours for each of the trainings listed for facility staff #s 1, 2 and 3.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-250-A
Description:	Based on the review of facility records and interviews conducted with facility staff the facility failed to ensure that a record was established for each staff person. Evidence: Facility staff # 3 Documented date of hire 01/17/2022 During the entrance interview facility staff #3 stated that she was the as needed (PRN) registered nurse for the facility and therefore did not have a facility record. The job description for facility staff #3 that was submitted for the inspector?s review on 06/13/2022 notes in part under the heading Responsibilities Include: ?Work on-site two to three times weekly; Communicates with all residents in regards to healthy choices, needs, etc; and Observe/Assist residents with setting up medications for self-administration indicating that staff #3 is personnel working at a facility that is compensated. The facility did not submit for the inspector?s review documented evidence that a facility record had been created for staff #3 that included a criminal records report and sworn disclosure statement, personal and social data, documentation of orientation and training, and credentials.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-260-A
Description:	Based on the review of facility records and interviews conducted the facility failed to ensure that each direct care staff member maintained current certification in first aid from the American Red Cross, American Heart Association, National Safety Council, American Safety and Health Institute, community college, hospital, volunteer rescue squad, or fire department. Evidence: The review of facility records with facility staff on 06/09/2022 revealed that the first aid certification for facility staff #1 expired on 05/14/2022.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-450-E
Description:	Based on the review of facility records and interviews conducted the facility failed to ensure that individualized service plans were signed and dated by the resident or his legal representative. Evidence: The review of resident records with facility staff revealed that the ISPs submitted for resident #s 1, 2 and 3 were not signed by the residents or their legal representative.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-660-B
Description:	Based on the review of facility records, interviews conducted and observation the facility failed to ensure that medications stored in residents? rooms were not accessible to other residents. Evidence: During the walk through of the facility on 06/09/2022 accompanied by staff #4 the unlocked bedrooms for resident #s 1, 2 and 4 were observed to have prescribed medications stored on the dresser and or bedside table.
Plan of Correction:	Not available online. Contact Inspector for more information.