VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Kingston Center
428 Cecil D. Quillen Drive
Thomas Village
Duffield, VA 24244
(276) 431-4200

Current Inspector: Rebecca Berry (276) 608-3514

Inspection Date: March 1, 2021

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 EMERGENCY PREPAREDNESS 22VAC40-90 The Sworn Statement or Affirmation 22VAC40-90 The Criminal History Record Report

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 03/01/2021 and concluded on 03/02/2021. The administrator was contacted by telephone to initiate the inspection. The administrator reported that the current census was 84. The inspector emailed the administrator a list of items required to complete the inspection. The inspector reviewed 5 resident records, 5 staff records, staff schedules for the past two weeks, Health care and dietitian oversight forms for the past year, the most recent fire and health inspection reports, and the fire and emergency drills for the past year, submitted by the facility to ensure documentation was complete. Information gathered during the inspection determined non-compliance(s) with applicable standards or law, and violations were documented on the violation notice issued to the facility.

Violations:

Standard #:	22VAC40-73-320-A
Description:	Based on review of resident records and the physical examination report, the facility failed to ensure all required information was contained on the physical examination report for one resident in care. EVIDENCE: 1. Resident # 1 was admitted to the facility on 01/9/2019. The physical examination report for this resident dated 01/08/2019 did not include a statement that specifies whether or not this resident is or is not capable of self-administering medications.
Plan of Correction:	In the future, will ensure that all physical examination reports include a statement that specifies whether or not the resident is or is not capable of self-administering medication. [sic]