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: Sept. 10, 2024

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 63.2 PROTECTION OF ADULTS AND REPORTING 22VAC40-90 BACKGROUND CHECKS FOR ASSISTED LIVING FACILITIES 22VAC40-90 THE SWORN STATEMENT OR AFFIRMATION 22VAC40-90 THE CRIMINAL HISTORY RECORD REPORT

Comments:

Type of inspection: Monitoring Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 09/10/2024 08:45am to 12:35pm 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: 5 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 3 Number of staff records reviewed: 2 Number of interviews conducted with residents: 2 Number of interviews conducted with staff: 4 Observations by licensing inspector: medication cart audio, lunch meal, morning activity 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 A Marie Swink, Licensing Inspector at 276-623-6575 or by email at angela.swink@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-50-A
Description:	Based on resident record review and staff interview, the facility failed to prepare and provide a statement to the prospective resident and his legal representative, if any, that discloses whether or not the facility has an on-site emergency electrical power source for the provision of electricity during an interruption of the normal electric power supply. EVIDENCE: 1. Resident 1 record, admission date 9/1/2024, contained an Assisted Living Facility Disclosure Statement that did not contain documentation of whether or not the facility has an on-site emergency electrical power source for the provision of electricity during an interruption of the normal electric power supply. 2. During an interview on the day of inspection between the licensing inspector and staff 1, staff 1 confirmed the disclosure statement did not contain documentation of whether or not the facility has an on-site emergency electrical power source for the provision of electricity during an interruption of the normal electric power supply.
Plan of Correction:	The administrator will use the new updated disclosure form that has the information to document whether or not the facility has an on-site emergency power source for the provisions of electricity during an interruption of the normal electric power supply.
Standard #:	22VAC40-73-250-D
Description:	Based on staff record review and staff interview, the facility failed to ensure each staff person on or within seven days prior to the first day of work at the facility submits the results of a risk assessment, documenting the absence of tuberculosis in a communicable form as evidenced by the completion of the current screening form published by the Virginia Department of Health or a form consistent with it. EVIDENCE: 1. Staff 5 record, hire date 4/22/2024, contained a risk assessment documenting the absence of tuberculosis dated 7/16/2024. 2. On the day of inspection, during an interview with the licensing inspector and staff 1, staff 1 confirmed staff 5 record to be current.
Plan of Correction:	The administrator and administrator?s assistant will ensure that each staff person will have tuberculosis screening documentation on or within seven days prior to employment.
Standard #:	22VAC40-73-260-A
Description:	Based on staff record review and staff interview, the facility failed to ensure each direct care staff member who does not have current certification in first aid as specified in subdivision 1 of this subsection received certification in first aid within 60 days of employment. EVIDENCE: 1. Staff 5 record, hire date 4/22/2024, did not contain documentation of a current certification in first aid. 2. On the day of inspection during an interview with the licensing inspector and staff 1, staff 1 confirmed staff 5 record to be current.
Plan of Correction:	The administrator and administrator?s assistant will ensure that all staff who do not have current certification in first aid have received certification within 60 days of employment.
Standard #:	22VAC40-73-680-I
Description:	Based on resident record review and staff interview, the facility failed to ensure that the Medication Administration Record (MAR) included the date and time given and initials of direct care staff administering the medication. EVIDENCE: 1.Resident 2 record contained a physician?s order dated 7/24/2024 with documentation for Check Blood Sugar 3 Times A Day for Sliding Scale Insulin (Humalog) and Humalog Kwikpen 100Units/ML Inject 3x Day per SS: 151 -199 = 2U, 200 -249 = 4U, 250-299 = 6U, 300-349 = 8U, 350- 399 = 10U for Diabetes. 2. Resident 2 record contained a September 2024 MAR with documentation for the 4pm Blood Sugar Test on 9/4 with a reading of 211 and 9/6 with a reading of 168 completed by staff 1. The MAR did not contain documentation with the date and time given, and initials of direct care staff administering the medication Humalog Kwikpen at 2U according to the Sliding Scale. 4. On the day of inspection during an interview with one licensing inspector and staff 1, staff 1 confirmed they did not record the date and time given and their initials for administering the medication. Staff 1 confirmed they did administer the medication with the prescribed dose per the sliding scale.
Plan of Correction:	All staff that administer medications will ensure that the Medication Administration Record (MAR) will be correctly documented including the date and time given with initials of the staff administering the medication.
Standard #:	22VAC40-73-950-E
Description:	Based on staff interview, The facility failed to ensure a semi-annual review was completed on the emergency preparedness and response plan for all residents with emphasis placed on an individual's respective responsibilities with documentation of completing by signing and dating. EVIDENCE: 1. On the day of inspection during an interview with the licensing inspector and staff 1, staff 1 revealed the facility had not completed a semi-annual review on the emergency preparedness and response plan for residents, and consequently had no documentation with signatures and dates for the completion.
Plan of Correction:	The administrator will ensure that when conducting the semi-annual review of the emergency preparedness and response plan for all residents that there is documentation for completing by having them or their appropriate family member signing and dating.