VIRGINIA DEPARTMENT OF SOCIAL SERVICES

International Rejuvenation Center
221 West Main Street
Marion, VA 24354
(276) 782-1819

Current Inspector: Crystal Mullins (276) 608-1067

Inspection Date: March 18, 2022

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES 22VAC40-73 PERSONNEL 22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-73 RESIDENT ACCOMODATIONS AND RELATED PROVISIONS 22VAC40-73 BUILDING AND GROUNDS

Comments:

The licensing inspector for the International Rejuvenation Center an unannounced inspection in response to a complaint that was received by the licensing office. Building observations, resident records, and resident interviews were completed relations to the allegations of building and grounds and resident accommodations. The preponderance of evidence gathered/reviewed during the investigation does support the allegations, so the complaint is determined to be valid and other non-reported issues were also found and cited. An exit interview was held with the administrator on 03/18/2022 and at that time the opportunity to gather information that was not easily located in the files was given. Please complete the columns for "description of action to be taken" and "date to be corrected" for each violation cited on the violation notice, then return a signed and dated copy to the licensing office within 10 calendar days (04/11/2022) of receipt. If you have any questions please feel free to contact your inspector at 276-608-1067. Thank you for your assistance and cooperation.

Violations:

Standard #:	22VAC40-73-100-C-2
Complaint related:	No
Description:	Based on observations made during the tour of the building and collateral interviews, the facility has failed to maintain an effective pest control program. EVIDNCE: 1. Per conversation with Collateral #2, the facility has been confirmed to have a bed bug infestation as well as a termite infestation. 2. Collateral #2 also stated this has been an on-going problem at this facility due to the size and quantity of bed bugs as well as the maturity of the termites. Collateral #2 also stated this will take at least six months to remedy. 3. Collateral #3 states she has provided the administrator with three different companies to exterminate the premises, and according to Collateral # 3 the administrator has failed to follow through. 4. After previous complaints of the same nature, the administrator showed receipts of payment on two occasions from September and October of 2021 to the LI to prove he was attempting to remedy the infestation.
Plan of Correction:	Action is per previous staff will follow up. [sic]
Standard #:	22VAC40-73-40-B
Complaint related:	No
Description:	Based on observations, documentation review, and collateral interviews made during the 03/18/2022 complaint investigation, the licensee failed to act in accordance with General Procedures outlined in 22 VAC 40-80-160 C. by not exhibiting traits of good character. EVIDENCE: 1. LI requested to see Resident #1?s file, to look at the Individualized Service Plan (ISP) and the Uniform Assessment Instrument (UAI). LI observed the UAI to be missing pages, and also noticed the UAI was not dated at the top right in the screening blank, assessment blank, nor the reassessment blank. LI requested Staff #1 make a copy of the UAI for the LI to take for further review, and to also collect the missing pages from the assessor. 2. When Staff #1 returned with the requested copy, the top right screen blank was found to be dated as 03/15/2022. LI asked Staff #1 how that date appeared, he replied that he had to send Resident #1 to the appropriate office building to request that a UAI be completed and that Collateral #1 was taking care of the UAI and she could get the LI the missing pages. Staff #1 used his personal cell phone to call Collateral #1. Staff #1 placed his phone on speaker and LI and Staff #1 was able to converse with Collateral #1. Collateral #1 did confirm that Resident #1 was sent to her office with a note that requested a UAI be completed on her. 3. LI asked Collateral #1 why she completed the UAI but Collateral #4 had signed the UAI as the screener. Collateral #1 confirmed Collateral #4 had not worked at their agency for at least a year and she was uncertain how it was possible for Collateral #4 to sign her name as the assessor on a UAI dated 03/15/2022. 4. LI confirmed with Collateral #1 that a UAI was completed on Resident #1 on 02/22/2021 at 8:15am-8:30am by Collateral #4. 5. Collateral #1 further confirmed that she has not completed the UAI for Resident #1 in its entirety and she has not sent it to the facility on the date of this inspection, 03/18/2022.
Plan of Correction:	Resident #1 was sent to CSL Mar 16, 22 to for DR case manager and med review and UAI. UAI are not dated sometimes by provider. In future make sure the UAI updated on front. Staff will monitor. [sic]
Standard #:	22VAC40-73-150-C
Complaint related:	No
Description:	Based on observations made during the tour of the building, along with resident and collateral interviews, the administrator has failed to demonstrate responsibility for the general administration and management of the facility and overseeing the day-to-day operation of the facility which includes ensuring that care is being provided to residents in a manner that protects their health and well-being, failing to maintain compliance with applicable regulations, failure to maintain the building and grounds and failure to implement Individualized Service Plans (ISPs) for each resident. EVIDENCE: 1. Resident #2 has an ISP dated 10/14/2021 which identified hoarding and housekeeping services as documented needs. According to the ISP, persons responsible for providing services for hording are the administrator, direct care staff, and/or medication aides. The services shall be provided on a daily basis at home, and Resident #2 will be encouraged to only keep a limited collection of items, and the goal is to keep the room neat and clean at all times. Persons responsible for providing housekeeping services are ALF housekeeper and ?PCAS?. This services is to be provided daily for Resident #2 at the home to ensure a clean living environment and staff will assist in keeping home and room clean and neat at all times. The room for Resident #2 was found to not have housekeeping services nor hoarding prevention carried through as defined in the ISP 2. The administrator has failed to maintain compliance with regulations as defined in the standards which have been cited in this violation notice as well as violation notices from 12/07/2021 and 07/12/2021 regarding the same physical plant issues as well as bed bug issues. 3. The administrator has failed to protect the health, safety, and well-being of the residents in the facility in regards to the infestation of termites and bed bugs per observations made by the LI an interview with Collateral #2. This issues has been ongoing since at least July 2021. The administrator did seek professional paid services according to receipts provided to the LI, but failed to continue with those services, which continued to allow the bed bug population to multiply. The administrator stated to the LI that he was purchasing a $3,000.00 (approximately) heating machine which would kill bed bugs. During this inspection on 03/18/2022 the LI asked to see the heating machine. Staff #2 showed LI what appeared to be a portable clothes steamer machine which rolled on wheels and had a vertical silver pole that held the steam-head.
Plan of Correction:	A complete up is continuing at facility, with permission of license office all residents might be moved to 2nd floor with limited stuff. Staff will follow up. [sic]
Standard #:	22VAC40-73-450-H
Complaint related:	No
Description:	Based on observations made during the tour of the building, the facility failed to ensure that the care and services specified in the Individualized Service Plan (ISP) are provided to each resident. EVIDENCE: 1. An ISP dated 10/14/2021 identified hoarding and housekeeping services as documented needs for Resident #2. 2. According to the ISP, persons responsible for providing services for hording are the administrator, direct care staff, and/or medication aides. The services shall be provided on a daily basis at home, and Resident #2 will be encouraged to only keep a limited collection of items, and the goal is to keep the room neat and clean at all times. 3. According to the ISP, persons responsible for providing housekeeping services are ALF housekeeper and ?PCAS?. This services is to be provided daily for Resident #2 at the facility to ensure a clean living environment and staff will assist in keeping facility and resident room clean and neat at all times. 4. Resident #2?s room (which is shared with Resident #1) was observed by the LI to have clothing, trash, laundry, blankets, shoes, book bags, purses and other items to be piled upon the bed approximately three feet tall. When the LI asked Resident #1 where she slept last night she stated she slept in the bed which was covered with all of the above mentioned items. 5. In the corner of Resident #1 and #2?s room there was a piece of furniture with a green chair, the entire surface area was observed to be covered with bags, books, dolls, and personal hygiene items approximately one foot high area; the piece of furniture appeared to be a desk. 6. In an opposite corner of the room there is a shelving unit with four shelves. This shelving unit is at its capacity with personal items. Directly in front of the storage unit there are at least five plastic totes that are stacked side beside and on top of one another approximately four feet high with various personal items of the residents to include a mop and bucket, at least four blankets, towels, a decorative box, a laundry basket filled with clothes and a plastic bag which is also full of the resident?s belongings. 7. In the same room, in front of what used to be a fire place there was a broom, dustpan, shoes, two lawn size black trash bags full of unidentified items, an oval plastic storage container approximately 18 inches long, and at least four bags of trash stacked up approximately two feet high.
Plan of Correction:	All areas of citation are being followed and staff will monitor regularly. [sic]
Standard #:	22VAC40-73-750-E
Complaint related:	No
Description:	Based on observations made during the tour of the building, the facility failed to have sufficient bed linens in good repair in each resident?s room. EVIDENCE: 1. Resident #3?s bed was observed to not have a bottom sheet or pillowcase available to Resident #3. 2. Resident #4 had sheets on the bed, however, there were 10-12 pencil eraser size blood stains/smears. These spots are visible due to bed bugs that have been on the linens and have been smashed, as Resident #4 displayed to LI on the date of the inspection (03/18/2022).
Plan of Correction:	We are trying our best and will continue with all options. Staff will routinely monitor. [sic]
Standard #:	22VAC40-73-780-B
Complaint related:	No
Description:	Based on observations made during the tour of the building and resident interviews, the facility failed to change bed linens at least every seven days and more if needed. EVIDENCE: 1. Residents #1, #4, and #5 stated their bed linens had not been changed in the last seven days. 2. The above mentioned residents have housekeeping and laundry services listed as an identified need on each of their ISPs.
Plan of Correction:	Get more linens. [sic]
Standard #:	22VAC40-73-860-D
Complaint related:	No
Description:	Based on observations made during the tour of the building, the facility failed to have all operable windows effectively screened. EVIDENCE: 1. Resident #2?s room has a window that is operable however this window was not effectively screened.
Plan of Correction:	Contracted for screen. [sic]
Standard #:	22VAC40-73-870-D
Complaint related:	No
Description:	Based on observations made during the tour of the building, the facility failed to keep the building free from infestations of insects and vermin and keep the grounds free of their breeding places. EVIDENCE: 1. Resident #5?s mattress cover was observed to have at least 5 bed bugs visible and at least one of those bugs were alive and crawling at the time the LI removed the fitted sheet. 2. Resident #5 has reported to LI that her arms itch and she has had what appeared to be bug bites visible on her arms. 3. During a previous inspection dated 12/07/2021, the LI observed what appeared to be raised red bug bites on Resident #5?s left forearm. Resident #5 stated ?I have bugs that crawl in my bed and I kill as many as I can so they will not bite me? during the 12/07/2021 visit. 4. Resident #5?s bed was observed to have bed bugs stuck to her sheets as well as bed bugs crawling thought her bed on the previous visit dated 12/07/2021. 5. Per conversation with Collateral #2, the facility has been confirmed to have a bed bug infestation as well as a termite infestation. Collateral #2 stated he could only treat for such infestations when and where the residents of the facility would cooperate and move their personal belongings as to allow treatment for such infestations as it is against their policy to move a person?s belongings/property. Collateral #2 also stated this has been an on-going problem at this facility due to the size and quantity of bed bugs as well as the maturity of the termites. Collateral #2 also stated this will take at least six months to remedy.
Plan of Correction:	We are paying $500 each time pest control. We have put cedar wood boards under beds checking with experts. Staff will continue to follow up. [sic]
Standard #:	22VAC40-73-870-E
Complaint related:	No
Description:	Based on observations made during the tour of the building, the facility failed to maintain all furnishings, fixtures, equipment, window coverings, sinks, toilets, bathtubs, and showers clean and in good repair and condition. EVIDENCE: 1. Room B.5, a common bathroom had more than 20 bugs visible in the overhead light. 2. Resident #5?s room was observed to have a white splattered substance on the headboard area of her bed approximately eight inches x 6 inches in area. 3. The wall behind Resident #5?s bed has decorative trim half way down from the ceiling. This trim is beige in color and separates the top of the wall, which is wallpapered from the bottom of the wall which is painted white. The trim was observed to have gray dust ? inch thick on the surface. 4. The white, bottom portion of the wall behind Resident #5?s headboard was observed to have two areas of gray dust approximately three feet in size. 5. The metal railings on the bed frame for Resident #5 was found to be discolored with a brown substance, a white splattered substance, and gray dust. 6. The common bathroom in the back of the building with a stand up shower stall was observed to have dirt and grime on the tile floor area. The grout of this tile shower floor was also observed to have a brown/black stain approximately six inches long.
Plan of Correction:	Have facility spic & span. Staff will continue to monitor. [sic]
Standard #:	22VAC40-73-920-C
Complaint related:	No
Description:	Based on observations made during the tour of the building, the facility failed to have ventilation to the outside in all bathrooms in order to eliminate foul odors. EVIDENCE: 1. Room B.5, a common bathroom had an overhead fan/vent that was inoperable.
Plan of Correction:	Replacing the exhaust. Staff will monitor. [sic]
Standard #:	22VAC40-73-925-B
Complaint related:	No
Description:	Based on observations made during the tour of the building, the facility failed to have liquid soap available at all common face/hand washing sinks. EVIDENCE: 1. The common bathroom across from the medication room did not have any liquid soap available at the face/hand washing sink.
Plan of Correction:	Replaced same time. Staff will monitor. [sic]