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: Aug. 20, 2024 and Aug. 29, 2024

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-73 BUILDINGS AND GROUND

Comments:

Type of inspection: Complaint Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 08/20/2024 (arrival 9:52am / departure 1:05pm) , and 08/29/2024 (arrival 10:30am / departure 5:00pm) 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 08/08/2024 regarding allegations in the area(s) of: Resident Care and Related Services, and Buildings and Grounds Number of residents present at the facility at the beginning of the inspection: 81 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 5 Number of staff records reviewed: 4 An exit meeting will be conducted to review the inspection findings. . The evidence gathered during the investigation supported some, but not all of the allegation(s) area(s) of non-compliance with standard(s) or law were: Resident Care and Related Services A violation notice was issued; any violation(s) not related to the complaint(s) but identified during the course of the investigation can also 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 Darunda Flint, Licensing Inspector at (757) 807-9731 or by email at Darunda.a.flint@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-325-B
Complaint related:	No
Description:	Based on record review and staff interview, the facility failed to ensure a fall risk rating was completed after a fall for a resident. Evidence: 1. Progress notes dated 05/12/2024 with a created date of 05/20/2024 for resident #1 documented a fall for resident #1. 2. The hospice notes dated 05/14/2024 for resident #1 documented the resident was sent to the ER (emergency room) for evaluation of pain from a fall several days ago. 3. On 05/16/2024, resident #1?s hospice note documented that resident #1 was discharged from acute care with a right femur fracture. 4. There was not a fall risk rating in the resident?s record for the aforementioned 05/12/2024 fall. 5. Staff #1 acknowledged the resident?s record did not include a fall risk rating, as required, for the fall that occurred on 05/12/2024.
Plan of Correction:	Date To Be Corrected: 10/12/2024 (Mandatory Resident Care Associate Meeting) 10/18/2024 (Mandatory Registered Medication Aide Meeting) Continuing monthly
Standard #:	22VAC40-73-450-E
Complaint related:	No
Description:	Based on the record review the facility failed to ensure the individualized service plan (ISP) shall be signed and dated by the licensee, administrator, or his designee, and by the resident or his legal guardian. Evidence: 1. Resident #2?s ISP dated 5/19/2024 was not signed and dated by the facility, resident, or the legal guardian. 2. Resident #3 ISP dated 06/05/2024 was not signed by the resident or the legal guardian. 3.Staff #1 acknowledged resident #2?s 05/19/2024 ISP, and resident #3?s 06/05/2024 ISP was not signed and dated by the aforementioned.
Plan of Correction:	Date To Be Corrected: 10/04/2024-continuing
Standard #:	22VAC40-73-460-F
Complaint related:	No
Description:	Based on record review, the facility failed to ensure that the facility shall notify the next of kin, legal representative, designated contact person, or, if applicable, any responsible social agency of any incident of a resident falling or wandering from the premises, whether or not it results in injury. This notification shall occur as soon as possible but no later than 24 hours from the time of initial discovery or knowledge of the incident. The resident's record shall include documentation of the notification, including date, time, caller, and person or agency notified. Evidence: 1. The review of facility documentation revealed that the facility did not notify resident #1?s legal representative regarding the resident?s 05/12/2024 fall. 2. Staff #1 acknowledged there was no documentation that the aforementioned resident?s family was notified of the resident falling on 05/12/2024.
Plan of Correction:	Date To Be Corrected: 10/12/2024 (Mandatory Resident Care Associate Meeting)10/18/2024 (Mandatory Registered Medication Aide Meeting) Continuing monthly
Standard #:	22VAC40-73-860-I
Complaint related:	No
Description:	Based on observation and staff interviewed, the facility failed to ensure cleaning supplies and other hazardous materials were stored in a locked area. Evidence: 1. On 08/20/2024, during a tour of the facility with staff #2, hazardous chemicals, Corrosive 8 and an electric power tool were being stored, in an unlocked area, outside on the porch in the resident courtyard. 2. Staff #2 acknowledged the aforementioned were being stored unlocked on the porch in the resident courtyard.
Plan of Correction:	Date To Be Completed: 08/20/2024-continuing