VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Rosewood Village Hollymead Assisted Living, LLC
2029 Lockwood Drive
Charlottesville, VA 22911
(434) 963-7673

Current Inspector: Shelby Haskins (804) 305-4876

Inspection Date: May 17, 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: Monitoring The licensing inspector was on-site at the facility on 5/17/2022 from 1:15p ? 1:45p. The Acknowledgement of Inspection form was signed and left at the facility. Additional Comments/Discussion: The licensing inspector interviewed the Administrator and DON about a self-report that an individual with a cognitive impairment eloped from the memory care unit. There were no injuries and the individual did not leave the property. An exit meeting was conducted to review the inspection findings. The evidence gathered during the initial inspection determined non-compliance with applicable standard(s) or law, and violation(s) were documented on the violation notice issued to the facility. The applicant had the opportunity to submit a plan of correction to indicate how the cited violation(s) will be addressed in order to maintain future compliance with applicable standard(s) or law. 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. Should you have any questions, please contact Tamara Watkins, Licensing Inspector at (804) 662-7422 or by email at tamara.g.watkins@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-1150-A
Description:	Based on review of an incident report from the facility and interviews with facility staff the facility failed to prohibit a resident in a safe secure environment from exiting the facility. Evidence: The facility reported an incident that occurred on April 7, 2022 when a resident eloped from the memory care community. Resident #1 was found by staff outside the memory care community, back parking lot, sitting in a team member?s car. The resident was redirected back to the community.
Plan of Correction:	One on one staff supervision was initiated for 72 hours. A walkthrough of Innovations Unit occurred by ED, DHW and Maintenance Director. STOP sign has posted on the door that the resident exited. Team members have been instructed to never use this door, unless in event of emergency. Volume of exit door alarms have been increased. Regular hourly safety checks continue to be in place.