VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Jeanne's Elderly Care
1682 Monterey Road
Roanoke, VA 24019
(540) 563-1262

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

Inspection Date: Oct. 14, 2022

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 22VAC40-80 THE LICENSE 22VAC40-80 THE LICENSING PROCESS 22VAC40-80 COMPLAINT INVESTIGATION 22VAC40-80 SANCTIONS

Comments:

Type of inspection: Renewal Date of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 10/14/2022 9:00am until 1:00pm 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: 6 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 4 Number of staff records reviewed: 3 Number of interviews conducted with residents: 1 Number of interviews conducted with staff: 2 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 Cynthia Ball-Beckner, Licensing Inspector at 540-309-2968 or by email at cynthia.ball@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 (UAI) were completed prior to admission. EVIDENCE: 1. The record for resident 3, admitted to the facility on 06/30/2022 has documentation that the UAI for this resident was not completed until 07/03/2022.
Plan of Correction:	All UAI?s will be completed prior to admissions or at the latest the day of admission.
Standard #:	22VAC40-73-450-A
Description:	Based on a review of resident records, the facility failed to ensure that resident individualized service plans (ISPs) were developed on or within seven days prior to the day of admission. EVIDENCE: 1. The record for resident 3, admitted to the facility on 06/30/2022, has documentation that the ISP for this resident was not completed until 07/03/2022.
Plan of Correction:	All ISP?s will be developed on or within seven days prior to the day of admission.
Standard #:	22VAC40-73-450-C
Description:	Based on a review of resident records, the facility failed to ensure that individualized service plans (ISPs) were updated to reflect current identified needs. EVIDENCE: 1. The record for resident 1 has a physician order dated 06/27/2022 for discontinue wound care and foley catheter for resident 1. The ISP dated 04/14/2022 in the record for resident 1 still has documentation that the services are being provided.
Plan of Correction:	ISP?s will be reviewed more frequently to make sure that they are updated and current on all residents needs.
Standard #:	22VAC40-73-680-D
Description:	Based on a review of resident records, the facility failed to ensure that medications were administered in accordance with physician instructions. EVIDENCE: 1. The October 2022 medication administration record (MAR) for resident 2 has documentation of a physician order for Humalog Kwikpen Insulin to be administered per sliding scale coverage instructions. On 10/1/2022 at 4:00pm it was noted that resident 2?s blood sugar was 185, requiring 2 units of Humalog Kwikpen Insulin. The MAR does not have documentation that this insulin was administered.
Plan of Correction:	In the future the medication aide or nurse will administer the Humalog Kwikpen and document appropriately according to the physician order.