VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Smith Mountain Lake Retirement Village
115 Retirement Drive
Hardy, VA 24101
(540) 719-1300

Current Inspector: Jennifer Stokes (540) 589-5216

Inspection Date: Aug. 11, 2022

Complaint Related: Yes

Areas Reviewed:

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: 08/11/2022 10:00AM through 11:30AM 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 07/11/2022 regarding allegations in the areas of: staffing and supervision and resident care and related services. An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation did not support the allegations of non-compliance with standard(s) or law. However, violation(s) not related to the complaint but identified during the course of the investigation can 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 Jennifer Stokes, Licensing Inspector at 540-589-5216 or by email at Jennifer.Stokes@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-220-B
Complaint related:	No
Description:	Based on observation, collateral interview and staff interview, the facility failed to ensure all requirements were met when private duty personnel, who are not employees of a licensed home care organization, provide direct care or companion services to resident in an assisted living facility. EVIDENCE: 1. During on-site inspection on 08/11/2022, the licensing inspector (LI) observed Collateral 1 in resident 1?s room. When the LI questioned Collateral 1 of her relation to resident 1, Collateral 1 stated that she performs sitter/companion services for resident 1 and also feeds resident 1 during meals as the resident does require to be spoon fed according to her uniform assessment instrument (UAI) dated 01/21/2022. Collateral 1 stated that she is not employed by a licensed home care organization but is employed by resident 1?s family. 2. During interview with staff 2 and 4 it was revealed that the facility does not have the documentation required of Collateral 1 to meet the requirements of this standard.
Plan of Correction:	The Administrator will have sufficient documentation on private duty personnel.