VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Town & Country Adult Care Residence
60 Town & Country Drive
Lebanon, VA 24266
(276) 889-3222

Current Inspector: Crystal Mullins (276) 608-1067

Inspection Date: Nov. 17, 2022

Complaint Related: No

Areas Reviewed:

22VAC40-73 GENERAL PROVISIONS 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 RESIDENT ACCOMMODATIONS AND RELATED PROVISIONS 22VAC40-73 BUILDINGS AND GROUND 22VAC40-73 EMERGENCY PREPAREDNESS 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS

Comments:

Type of inspection: Renewal Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 11/17/2022 The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. Begin: 9:00am End: 1:52pm The evidence gathered during the inspection determined non-compliance with applicable standard(s) or law, and violation(s) were documented on the violation notice issued to the facility. 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 Crystal B. Henson, Licensing Inspector at 276-608-1067 or by email at crystal.b.mullins@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-320-A
Description:	Based on a review of resident records, the facility failed to ensure all required information was documented on the physical exam completed within 30 days prior to admission. EVIDENCE: 1. The physical examination dated 06/01/2022 in the record for Resident #1 is incomplete as the section addressing general physical condition, including a systems review as is medically indicated, is blank. 2. The physical examination dated 06/01/2022 in the record for Resident #1 is incomplete as the statement specifying whether the individual is or is not capable of self-administering medication is illegible.
Plan of Correction:	Administrator has sent documents of resident 1 to doctor to be completed. [sic]
Standard #:	22VAC40-73-410-A
Description:	Based on a review of resident records, the facility failed to ensure an acknowledgement of orientation was dated by a resident. EVIDENCE: 1. The acknowledgment of having received the orientation in the record for Resident #2 was signed by the resident, but not dated.
Plan of Correction:	Administration has dated the orientation for resident 2. [sic]
Standard #:	22VAC40-73-430-H-1
Description:	Based on a review of resident records, the facility failed to ensure a discharge statement was completed for a former resident. EVIDENCE: 1. Resident # 5 was discharged on or around 08/16/2022. A dated discharge statement signed by the administrator was not found in the record for resident #5. A copy of a completely blank discharge statement form was found in the record.
Plan of Correction:	Administrator has completed a discharge statement for resident 5. [sic]
Standard #:	22VAC40-73-450-C
Description:	Based on a review of resident records, the facility failed to address all identified needs on Individualized Service Plans (ISP?s) for two of four resident files that were reviewed. EVIDENCE: 1. The record for Resident #1 has a physician?s order for oxygen, 2 liters via nasal cannula as needed for shortness of breath, dated 11/16/2022. The ISP dated 06/30/2022 in the record for Resident #1 has not been updated to reflect the use of oxygen, in the following areas: a written description of what services will be provided to address identified needs, and if applicable, other services, and who will provide them; when and where the services will be provided; the expected outcome and time frame for expected outcome. 2. The UAI dated 08/02/2022 in the record for Resident #3 identifies using phone as an area in which the resident needs help. The ISP dated 08/02/2022 in the record for Resident #3 does not address the need of using phone in the following areas: description of identified needs and date identified based upon the UAI; a written description of what services will be provided to address identified needs, and if applicable, other services, and who will provide them; when and where the services will be provided; the expected outcome and time frame for expected outcome.
Plan of Correction:	Administrator has documented oxygen use on ISP of resident 1. [sic]
Standard #:	22VAC40-73-870-E
Description:	Based on observations made during the tour of the building, the facility failed to maintain all fixtures and equipment in good repair and condition. EVIDENCE: 1. The left shower stall in the men?s common restroom across from the medication room was inoperable.
Plan of Correction:	Left shower stall in men's common bathroom as soon as the parts come in. [sic]