VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Timberview Crossing
351 New Market Road
Timberville, VA 22853
(540) 896-9858

Current Inspector: Jill James (540) 418-2631

Inspection Date: Oct. 27, 2020

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 ACCOMODATIONS AND RELATED PROVISIONS 22VAC40-73 EMERGENCY PREPAREDNESS 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

Technical Assistance:

Discussion occurred on the following topic: Mobility refers to movement outside of normal living quarters.

Comments:

This inspection was conducted by licensing staff using an alternate remote protocol necessary due to a state of emergency health pandemic declared by the Governor of Virginia. A renewal inspection was initiated on 10/27/20 and concluded on 11/11/20. The administrator was contacted by telephone to initiate the inspection. The administrator reported the census was 28. The inspector emailed the administrator a list of items required to complete the inspection. The inspector reviewed three resident records, three staff records, physician's orders, medication administration records, record of fire drills and staff schedules submitted by the facility to ensure documentation was complete. Information gathered during the inspection determined non-compliance with applicable standards or law, and violations were documented on the violation notice issued to the facility.

Violations:

Standard #:	22VAC40-73-450-C
Description:	Based upon review of residents' records, the facility failed to ensure the identified needs of the resident are reflected on the Individualized Service Plan (ISP). EVIDENCE: 1) The ISP indicates resident A is disoriented to all spheres some of the time and staff will re-orient to highest level of ability. The ISP does not include spheres affected and description of the interventions used to re-orient resident. b. The ISP for resident A indicates DNR status. The DNR for resident does not contain a signature. 2) The UAI indicates resident B is disoriented to some spheres some of the time. The ISP indicates resident is alert and oriented.
Plan of Correction:	ISP/UAI corrected on11/13/20. An ISP refresher is scheduled for all staff responsible for ISP/UAIs 11/17/20. Regional administrator to review ISP/UAIs every other month until next Oversight 11/13/20.