VIRGINIA DEPARTMENT OF SOCIAL SERVICES

The Haven Assisted Living @ Eleanor
7472 Eleanor Drive
5515 Mechanicsville Turnpike
Mechanicsville, VA 23111
(804) 730-2846

Current Inspector: Kimberly Davis (804) 662-7578

Inspection Date: Oct. 23, 2020 and Oct. 26, 2020

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 ACCOMODATIONS AND RELATED PROVISIONS 22VAC40-73 BUILDING AND GROUNDS 22VAC40-73 EMERGENCY PREPAREDNESS 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 22VAC40-80 THE LICENSE. 22VAC40-80 THE LICENSING PROCESS.

Technical Assistance:

Licensing Inspector advised administrator to check VDSS website for current Report of Physical Examination form.

Comments:

This inspection was conducted by licensing staff using an alternate remote protocol necessary due to a state of emergency health pandemic declared by the Governor of Virginia. A renewal inspection was initiated on October 23, 2020 and concluded on October 26, 2020. The administrator was contacted by telephone to initiate the inspection. The administrator reported that the current census was 7. The inspector emailed the administrator a list of items required to complete the inspection. The inspector reviewed 2 resident records, 2 staff records, physician's orders, Medication Administration Records (MARs), and other facility documentation submitted by the facility to ensure documentation was complete. Information gathered during the inspection determined non-compliance(s) with applicable standards or law, and a violation was documented on the violation notice issued to the facility. Please specify how the violation will be corrected. The plan must contain: 1) step(s) to correct the non-compliance with the standard(s), 2) measures to prevent the non-compliance from occurring again; and 3) person(s) responsible for implementing each step and/or monitoring any preventative measure(s). Thank you for your cooperation during this inspection. I can be reached at Kimberly.M.Davis@dss.virginia.gov or (804) 662-7578.

Violations:

Standard #:	22VAC40-73-320-A
Description:	Based on a review of resident records, the facility failed to ensure that each resident's physical examination contained a statement that specifies whether the individual is or is not capable of self-administering medication. Evidence: The report of physical examination for Resident # 1 did not contain a statement that specifies whether the resident is or is not capable of self-administering medication.
Plan of Correction:	The latest physical form was printed to have filled out by the provider. The latest physical form will be used going forward.