VIRGINIA DEPARTMENT OF SOCIAL SERVICES

COMMONWEALTH SENIOR LIVING AT HAMPTON
1030 TOPPING LANE
Hampton, VA 23666
(757) 826-3728

Current Inspector: Darunda Flint (757) 807-9731

Inspection Date: Nov. 18, 2022 , Dec. 12, 2022 , Dec. 20, 2022 and Dec. 22, 2022

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES 22VAC40-73 PERSONNEL 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

Comments:

Type of inspection: Complaint An unannounced complaint inspection was conducted on-site on 11-18-22 and 12-12-22. The facility census was 77.The inspection exit meetings were conducted with the assistant administrator. The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. A complaint was received by VDSS Division of Licensing on 10-17-22 regarding allegations in the area of resident care and related services. Number of residents present at the facility at the beginning of the inspection: 77 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 4 Number of staff records reviewed: Number of interviews conducted with residents: Number of interviews conducted with staff: 4 Observations by licensing inspector: Additional Comments/Discussion: An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation did not support the allegations of non-compliance with standard(s) or law. However, violation(s) not related to the complaint but identified during the course of the investigation can be found on the violation notice. The licensee has the opportunity to submit a plan of correction to indicate how the cited violation(s) will be addressed in order to return the facility to compliance and maintain future compliance with applicable standard(s) or law. 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. For more information about the VDSS Licensing Programs, please visit: www.dss.virginia.gov Should you have any questions, please contact (Willie Barnes) Licensing Inspector at (757) 439-6815 or by email at willie.barnes@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-320-B
Complaint related:	No
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure a risk assessment for tuberculosis (TB) was completed annually for one of four residents. Evidence: 1. On 11-18-22 during a complaint inspection and record review with staff #3, resident #4?s record did not have documentation of an annual TB assessment. The resident?s date of admission was noted as 2-26-18. The included documentation of TB?s dated 2-22-18, 7-25-28, 4-5-19, 3-5-20, 10-6-20 and 11-20-20. The record provided the inspector on 11-18-22 did not include documentation of a current TB. 2. On 11-18-22, during exit meeting, staff #2 and #3 acknowledged the record did not include a current TB assessment.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-440-K
Complaint related:	No
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure for private pay individuals, the uniform assessment instrument (UAI) should be in complete as required. Evidence: 1. On 11-18-22 during a complaint inspection and record review with staff #3, residents #1 and #2?s UAI dated 7-28-22 documented one staff member?s signature. Another designee or administrator?s signature was not documented. 2. On 11-18-22, during exit meeting, staff #2 and #3 acknowledged the UAI?s was not completed as required.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-450-C
Complaint related:	No
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure the individualized service plan (ISP) included all assessed needs. Evidence: 1. On 11-18-22 during complaint inspection resident #1?s individualized service plan (ISP) dated 8-17-22 did not include the resident?s pacemaker. This information was noted in the resident?s history document dated 7-28-22 from a local physician?s office. This information was not on the ISP in the record provided to the inspector on 11-18-22. 2. Resident #3?s ISP in the record provided on 11-18-22 and dated 12-21-21 documented the resident is a ?Full Code?. The record included a Do-Not Resuscitate (DNR) signed and dated by a physician on 3-8-22. The resident?s physical examination dated 12-21-21 documented resident allergic to PNC, Statins, Sulfa, Tramadol and Azithromycin. This information was also documented in the resident?s physician visit dated 1-6-22. The allergies were not on the ISP in the record provided to the inspector on 11-18-22. 3. Resident #4?s UAI dated 5-21-22 assessed walking need as mechanical help/physical assistance; wheeling as mechanical help/supervision; stairclimbing as mechanical help/physical assistance. The ISP dated 5-29-22 by staff and 8-25-22 by the legal representative did not include these assessed needs. The need transferring was assessed as mechanical help; the ISP documented resident did not need assistance and services to be provided by staff as reviewed in the record provided to the inspector on 11-18-22. 4. On 11-18-22, during exit meeting, staff #2 and #3 acknowledged the residents? ISP did not include all assessed needs.
Plan of Correction:	Not available online. Contact Inspector for more information.