VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Clara's Residential Assisted Living
1638 W. Grace Street
Richmond, VA 23220
(804) 353-6573

Current Inspector: Coy Stevenson (804) 972-4700

Inspection Date: Nov. 17, 2020 and Nov. 18, 2020

Complaint Related: No

Areas Reviewed:

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 22VAC40-90 The Sworn Statement or Affirmation 22VAC40-90 The Criminal History Record Report 22VAC40-80 THE LICENSE.

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 11/17/2020 and concluded on11/20/2020. The administrator was contacted by telephone to initiate the inspection. The administrator reported that the current census was 12. The inspector emailed the administrator a list of items required to complete the inspection. The inspector reviewed 2 resident records, 2 staff records, required facility documentation, medication administration records, physician orders and criminal history records submitted by the facility to ensure documentation was complete. An exit meeting was held with the administrator. 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. Please complete the "plan of correction" and "date to be corrected" for each violation cited on the violation notice and return to the Inspector within 10 days. 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 non-compliance 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). Please contact me by e-mail at T.Lesley@dss.virginia.gov if further assistance is needed.

Violations:

Standard #:	22VAC40-73-450-F
Description:	Based on review of resident records, the facility failed to ensure that all individualized service plans (ISP) be reviewed and updated as needed. Evidence: 1) The ISP dated 4/3/2020 for Resident #1 (Date of admission: 4/3/19) does not have a description of identified need for money management, which was assessed as a need on UAI dated 4/27/2020. 2) The ISP dated 4/3/2020 for Resident #1 (Date of admission: 4/3/19) does not have a description of identified need for mental health services, which was assessed as a need on UAI dated 4/27/2020.
Plan of Correction:	1) The ISP has been updated to reflect resident #1 need for money management. Administrator will review UAI more thoroughly to address description of all resident needs. 2) The ISP has been updated for correction of resident #1 mental health services. It was documented that resident #1 not only have a mental helth skill builder, but also receive services from a psychiatrist. Administrator will review UAI more intensely.