VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Our Father's House Christian Home
15261 Jubilee Road
Culpeper, VA 22701-4501
(540) 727-8292

Current Inspector: Sarah Pearson (540) 680-9469

Inspection Date: May 30, 2023

Complaint Related: No

Areas Reviewed:

Administration and Administrative Services Personnel Staffing and Supervision Admission, Retention and Discharge of Residents Resident Care and Related Services Resident Accommodations and Related Provisions Building and Grounds Emergency Preparedness Additional Requirements for Facilities that Care for Adults with Cognitive Impairments Background Checks for Assisted Living Facilities Sworn Statement

Comments:

Date of Inspection: May30, 2023 Type of Inspection: Monitoring Inspection Census 21 Number of records reviewed and interviews conducted- 6 records, 4 interviews. All facility self-reported incidents since the last inspection were reviewed on this date. The LI observed residents participating in activity programs and eating lunch. This Licensing Inspector observed a medication administration pass. If you have any questions or email changes, please do not hesitate to contact me at sarah.pearson@dss.virginia.gov. If you need a copy of any of the DSS Model forms or to review any inspection or regulation, you can find the information on the internet: www.dss.virginia.gov. The Licensing Inspector and the Administrator discussed the risk assessment ratings for the violations for this inspection. Please complete the ?plan of correction? and ?date to be corrected? for each violation cited on the violation notice and returned it to the office. You will need to specify how the deficient practice will be or has been corrected. Your plan of correction must contain: 1) steps to correct the noncompliance with the standard(s), 2) measures to prevent the noncompliance from occurring again; and 3) person(s) responsible for implementing each step and/or monitoring any preventive measure(s). The completed corrective action needs to be in the licensing office by June 8, 2023

Violations:

Standard #:	22VAC40-73-450-C
Description:	Based on resident record review and staff interview, it was determined that the Individualized Service Plan did not reflect the resident's current needs based on the Uniform Assessment Instrument. Evidence: Resident A and B's Individualized Service Plan did not correspond to their UAI.
Plan of Correction:	The service plan for the two elders who were cited in the violation report will be corrected immediately to include type of mechanical supports used - such as grab bars, walkers, etc. We will also begin including this information in service plans completed in the future.