VIRGINIA DEPARTMENT OF SOCIAL SERVICES

The Glebe
200 The Glebe Boulevard
Daleville, VA 24083
(540) 591-2100

Current Inspector: Angela Marie Swink (276) 623-6575

Inspection Date: April 10, 2024

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 ARTICLE 1 ? SUBJECTIVITY 32.1 REPORTED BY PERSONS OTHER THAN PHYSICIANS 63.2 GENERAL PROVISIONS 63.2 PROTECTION OF ADULTS AND REPORTING 63.2 LICENSURE AND REGISTRATION PROCEDURES 63.2 FACILITIES AND PROGRAMS 22VAC40-90 BACKGROUND CHECKS FOR ASSISTED LIVING FACILITIES 22VAC40-90 THE SWORN STATEMENT OR AFFIRMATION 22VAC40-90 THE CRIMINAL HISTORY RECORD REPORT

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: 4/10/2024 08:00am to 3:00pm The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. Number of residents present at the facility at the beginning of the inspection: 45 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: 3 Number of interviews conducted with residents: 2 Number of interviews conducted with staff: 4 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 A Marie Swink, Licensing Inspector at 276-635-6575 or by email at angela.swink@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-1180-B
Description:	Based on observations of the physical plant, the facility failed to ensure when there are indications that ordinary materials or objects may be harmful to a resident, these materials or objects shall be inaccessible to the resident. EVIDENCE: 1. One Licensing Inspector and staff person 2 observed the laundry room, in the safe, secure unit that provides care to residents that have a serious cognitive impairment, near the back hallway near the second nurses? station to be unlocked and accessible to enter by residents. A 30 FL OZ bottle containing Shout Triple Acting Laundry Stain Remover was observed in the top right unlocked cabinet in this laundry room which was accessible to residents. The bottle had language on its label that stated KEEP OUT OF REACH OF CHILDREN AND PETS.
Plan of Correction:	Plan of Correction: This plan of correction is the written allegation of compliance for the deficiencies cited. The submission of this plan of correction is not an admission that a deficiency exists or that one was incorrectly cited. This plan of correction is submitted to meet the requirements established by state regulations. On 4/10/2024 the laundry room door with the keyless entry mechanism did not engage and lock in the Chaplick Center Memory Care neighborhood. The door was easily opened and accessible for entry. Upon entry, behind a closed cabinet door was a bottle of Shout Triple Acting Stain Remover used for laundering purposes. On 4/10/2024 The Director of Facilities Services was immediately notified and determined no reason why the door did not engage. There was no issue with the keyless entry mechanism and the laundry room door has been functioning properly and locking since the initial occurrence. Team members will be re-educated on the importance of checking doors to ensure engagement of the keyless entry mechanism to prevent accidental injury from chemicals and/or cleaning products that require a secure and locked storage location. Re-education with team members will be completed by 5/1/2024. The community will ensure compliance by 4/12/2024 through random environmental audits to ensure doors with keyless entry devices are engaging properly and verify the doors are locked. Weekly x 4 weeks then monthly x 3 months and report findings during the quarterly QA meeting.