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: May 6, 2024 and May 15, 2024

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 PERSONNEL 22VAC40-73 STAFFING AND SUPERVISION 22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-80 COMPLAINT INVESTIGATION

Comments:

Type of inspection: Complaint Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 5/6/2024 12:50pm to 1:30pm 5/15/2024 1:30pm to 2:10pm The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. A complaint was received by VDSS Division of Licensing on 5/1/2024 regarding allegations in the area(s) of: Personnel, Staffing and Supervision, Resident Care and Related Services Number of residents present at the facility at the beginning of the inspection: 3 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 1 Number of staff records reviewed: 0 Number of interviews conducted with residents: 0 Number of interviews conducted with staff: 4 An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation supported some, but not all of the (allegation(s)/self-report); area(s) of non-compliance with standard(s) or law were: A violation notice was issued; any violation(s) not related to the (complaint(s)/self-report) but identified during the course of the investigation can also be found on the violation notice. 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 A Marie Swink, Licensing Inspector at 276-635-6575 or by email at angela.swink@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-450-C
Complaint related:	No
Description:	Based on resident record review and staff interview, the facility failed to ensure the comprehensive individualized service plan included the description of identified needs and date identified based upon the assessment of psychological, behavioral, and emotional functioning. EVIDENCE: 1. The record for resident 1 has a progress note dated 3/18/2024 with documentation that the resident was placing their self in the floor, exhibiting behaviors consistent with agitation, and throwing items. 2. The record for resident 1 has documentation in the communication log on 3/23/2024 and 3/24/2024 resident was troublesome, on 4/9/2024 resident was uncooperative, and 4/24/2024 resident has been hallucinating. 3. During an interview with the licensing inspector and staff person 1 and staff person 2, both staff persons confirmed the resident would place their self in the floor often due to exhibiting behaviors consistent with agitation and confirmed the behaviors noted in the nurse notes. 4. The record for resident 1 has a Comprehensive Individualized Service Plan dated 1/15/2024 however it does not contain documentation for the behavioral and emotional functioning needs of the resident.
Plan of Correction:	In the future the administrator will make sure to document on the ISP any behavioral, emotional and psychological functions as they change with resident needs