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: Jan. 21, 2021 , Jan. 22, 2021 , Jan. 25, 2021 , Jan. 26, 2021 and Jan. 27, 2021

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 STAFFING AND SUPERVISION 22VAC40-73 ADMISSION, RETENTION, AND DISCHARGE OF RESIDENTS 22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS Article 1 Subjectivity

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 complaint inspection was initiated on 1/21/21 and concluded on 1/27/21. A complaint was received by the department regarding allegations in the area of notification of family member after an incident. The Administrator was contacted by telephone to conduct the investigation. The licensing inspector emailed the Administrator a list of documentation required to complete the investigation. The evidence gathered during the investigation did not support the allegation of non-compliance with standards or law. Any violations not related to the complaint but identified during the course of the investigation can be found on the violation notice.

Violations:

Standard #:	22VAC40-73-450-C
Complaint related:	No
Description:	Based on record review and discussion, the facility failed to ensure the Individualized Service Plan (ISP) included description of identified needs based upon the Uniform Assessment Instrument (UAI). Evidence: 1. Resident #1 UAI dated 8/14/2020 documented incontinence with bowel and bladder. The resident?s ISP dated 8/14/2020 did not document the need. 2. Staff #4 acknowledged Resident #1?s ISP dated 8/14/2020 did not document incontinence with bowel and bladder.
Plan of Correction:	RCD made correction to ISP to reflect incontinence of bowel and bladder. RCD & ED will review ISP to ensure correct level of care in regards to incontinence level is indicated.
Standard #:	22VAC40-73-450-F
Complaint related:	No
Description:	Based on record review and discussion, the facility failed to update the Individualized Service Plan as needed for a significant change of a resident?s condition. Evidence: 1. Resident #3 was admitted on 2/8/18 with a regular diet. Physician?s order dated 11/24/2020 documented a new order for ?no added salt diet?. 2. Resident #3?s ISP dated 8/14/2020 did not reflect the change in the diet.
Plan of Correction:	RCD made correction to ISP to reflect "no added salt diet". RCD & ED will review ISPs to ensure correct diets and changes in diet are reflected.