VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Brookdale Chambrel Williamsburg
3800 TREYBURN DRIVE
Williamsburg, VA 23185
(757) 220-1839

Current Inspector: Margaret T Pittman (757) 641-0984

Inspection Date: March 6, 2023 , May 5, 2023 , May 9, 2023 and May 25, 2023

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 BUILDINGS AND GROUND

Comments:

Type of inspection: Complaint An unannounced complaint inspection was conducted on 3-6-23 (Ar 9:45 am/dep 5:20 pm). 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 1-25-23 regarding allegations in the resident care and related services: nutrition-buildings and grounds-resident care needs. Number of residents present at the facility at the beginning of the inspection: 128 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 3 Number of staff records reviewed: 0 Number of interviews conducted with residents: 1 Number of interviews conducted with staff: 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 #:	22VAC40-73-380-B
Complaint related:	No
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure the resident?s personal and social data was kept current. Evidence: 1. On 3-6-23 during a compliant inspection, resident #1?s personal social data form documented resident?s code status as ?DNR?. The individualized service plan (ISP) dated 5-12-22 documented the resident was a ?Full Code?. Collateral interview revealed resident is a full code. 2. On 3-6-23, staff acknowledged the aforementioned resident?s personal and social data form was not updated.
Plan of Correction:	? The Executive Director, Health and Wellness Director or designee will update resident number 1 personal and social information with ?Full Code? by June 1, 2023. ? The Executive Director or designee will provide education for the Sales Director, Sales Managers, Health and Wellness Directors and Health and Wellness Coordinators on the residents? personal and social information and DNR/Full Code by June 15, 2023.. ? The Health and Wellness Director or Designee will audit all current residents? records personal and social information for DNR by June 30, 2023. ? To assist with ongoing compliance, the Health and Wellness Director or Designee will audit 5% of current residents? personal and social information for DNR/Full Code monthly for two months.
Standard #:	22VAC40-73-450-C
Complaint related:	No
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure the comprehensive service plan included all assessed needs. Evidence: 1. On 3-6-23, resident #2?s uniform assessment instrument (UAI) dated 2-22-23 documented mobility need assessed as mechanical help/physical assistance. The individualized service plan (ISP) signed by the legal representative on 2-11-23 documented, resident needed, ?one person assistance to get to doctor appointments and place to place?.
Plan of Correction:	The following is the Plan of Correction for Brookdale Chambrel Williamsburg, Virginia regarding the Statement of Deficiencies dated 5/25/2023. This Plan of Correction is not to be construed as an admission of or agreement with the findings and conclusions in the Statement of Deficiencies, or any related sanction or fine. Rather, it is submitted as confirmation of our ongoing efforts to comply with statutory and regulatory requirements. In this document, we have outlined specific actions in response to identified issues. We have not provided a detailed response to each allegation or finding, nor have we identified mitigating factors. We remain committed to the delivery of quality health care services and will continue to make changes and improvement to satisfy that objective. ? The Executive Director, Health and Wellness Director or designee will update the Individualized Service Plans with current care needs for resident number 2 by 6/1/2023. ? The Executive Director or designee will provide education for the Health and Wellness Directors, Health and Wellness Coordinators on Individualized Service Plans and Care needs by 6/15/2023. ? The Executive Director, Health and Wellness Director, Health and Wellness Coordinator or designee will audit current residents Individualized Service Plans and Care needs by 6/30/2023. ? To assist with ongoing compliance, The Health and Wellness Director or designee will audit 5% of current resident Individualized Service Plans and care needs monthly for two months.