VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Chestnut Grove Assisted Living Facility
9010 Woodman Road
Richmond, VA 23228
(804) 262-7333

Current Inspector: Angela Rodgers-Reaves (804) 662-9774

Inspection Date: April 19, 2024

Complaint Related: No

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: On 04/18/2024 approximate time 10:15-12:25p.m On 04/19/2024 approximate time 11:54a.m-2:38P.m. 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: 62 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 8 Number of staff records reviewed: 4 Number of interviews conducted with residents: 4 Number of interviews conducted with staff: 4 Observations by licensing inspector: An afternoon medication administration pass was observed on 04/19/2024 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 Angela Rodgers-Reaves, Licensing Inspector at (804) 840-0253 or by email at Angela.r.reaves@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-970-A
Description:	Based on the review of facility records and interview with the Administrator the facility failed to ensure that the fire and emergency evacuation drills are conducted in accordance with the current edition of the Virginia Statewide Fire Prevention Code (13VAC5-51). The drills required for each shift in a quarter shall not be conducted in the same month. Evidence: Facility documentation reviewed with the Administrator revealed that no fire drill was conducted for the month of March 2024
Plan of Correction:	THE FACILITY'S RESPONSE: " The Administrator, Maintenance Director, and or designee will ensure that the facility conducts the fire and emergency evacuation drills monthly and will be conducted in accordance with the current edition of the Virginia Statewide Fire Prevention Code (13VAC5-51). The drills will be conducted monthly and will cover each shift in a quarter."