VIRGINIA DEPARTMENT OF SOCIAL SERVICES

COMMONWEALTH SENIOR LlVING AT CHURCHLAND HOUSE
4916 West Norfolk Road
Portsmouth, VA 23703
(757) 483-1780

Current Inspector: Donesia Peoples (757) 353-0430

Inspection Date: Nov. 25, 2019

Complaint Related: No

Areas Reviewed:

22VAC40-73 RESIDENT CARE AND RELATED SERVICES

Comments:

This was an unannounced focused monitoring inspection conducted by the Licensing Inspector from the Eastern Regional Office on November 25, 2019 from 9:56 am until 1:06 pm. There were 61 residents in care. During the inspection, resident records were reviewed with a focus on resident falls. Staff schedules were also reviewed as well as the facility?s call bell response time logs. There was a discussion regarding fall precautions and staff response times to call bells. Also discussed mechanical devices on the Individualized Service Plan (ISP). The facility received one violation in the area of Resident Care and Related Services. Findings were discussed with the Administrator throughout the inspection and during the exit interview. Please complete the ?plan of correction? and ?date to be corrected? for each violation cited on the violation notice. The plan of correction must indicate how the violation(s) will be or has been corrected. The plan of correction should include: 1. Step(s) to correct the non-compliance with the standard(s) 2. Methods to prevent re-occurrence and, 3. Person(s) responsible for implementing and/or monitoring any preventive action.

Violations:

Standard #:	22VAC40-73-440-D
Description:	Based on record review and interview, the facility failed to ensure one out of three Uniform Assessment Instruments (UAI) was completed as required by 22VAC30-110. Evidence: 1. Resident # 3's most recent UAI dated 10/10/19 was not signed or dated by the assessor. 2. During interview, staff #1 and staff #2 stated staff #2 was the assessor and acknowledged the UAI was not signed.
Plan of Correction:	Signatures were obtained on the ISP [UAI] of Resident #3. All UAIs were audited for appropriate signatures. Re-in-serviced Resident Care Director and Assistant Resident Care Director on DSS Standard 73-440-D. Executive Director or designee will audit a minimum of 5 resident UAI?s per month to ensure accuracy for continued compliance.