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: Feb. 24, 2023

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 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: 02/24/2023, 9:24am to 3:43pm 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: 90 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 9 Number of staff records reviewed: 5 Number of interviews conducted with residents: 4 Number of interviews conducted with staff: 2 Observations by licensing inspector: Additional Comments/Discussion: An exit meeting will be conducted to review the inspection findings. 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 Becky Berry, Licensing Inspector at 276-608-3514 or by email at rebecca.berry@dss.virginia.gov.

Violations:

Standard #:	22VAC40-73-440-A
Description:	Based on a review of resident records, the facility failed to ensure that Uniform Assessment Instruments (UAIs) were completed as required. EVIDENCE: 1. The UAIs dated 11/04/2022 for resident #2, 01/23/2023 for resident #5, 05/19/2022 for resident #6 and 01/23/2023 for resident #7 have documentation that medications are administered by professional nursing staff. These residents also receive medication administration from facility Registered Medication Aides (RMAs) who are considered laypersons on the UAI form.
Plan of Correction:	Scott County Department of Social Services and Frontier Health, local assessors of facility residents, have been notified that in the future, all Uniform Assessment Instruments (UAI's) must document that medication administration is administered/monitored by a lay person. [SIC]
Standard #:	22VAC40-73-440-D
Description:	Based on a review of resident records, the facility failed to ensure that private pay Uniform Assessment Instruments (UAIs) were completed as required. EVIDENCE: 1. The UAIs dated 08/25/2022 for resident #3, 01/23/2023 for resident #4, 06/10/2022 for resident #8 and 11/09/2022 for resident #9 have documentation that medications are administered by professional nursing staff. These residents also receive medication administration from facility Registered Medication Aides (RMAs) who are considered laypersons on the UAI form.
Plan of Correction:	In the future, all Uniform Assessment Instruments (UAI's) will have documentation that medications are administered by laypersons. [SIC]
Standard #:	22VAC40-73-750-B
Description:	Based on observations made during the tour of the facility, the facility failed to ensure each resident bedroom contained a sturdy chair for each resident. EVIDENCE: 1. Room C14 has two residents in the room and only one chair. 2. Room C12 has two residents in the room and no chairs available to residents.
Plan of Correction:	Room C14 has had a chair placed in the room. Room C12 has two chairs placed in the room. In the future, all resident rooms will contain adequate sturdy chairs for the occupants of the room, unless there is written documentation that a resident does not wish to have a sturdy chair in their room. [SIC]