VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Jan's Residential Home I
307 N. High Street
P. O. Box 666
Blackstone, VA 23824
(434) 298-0993

Current Inspector: Coy Stevenson (804) 972-4700

Inspection Date: March 14, 2022

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES 22VAC40-73 RESIDENT CARE AND RELATED SERVICES

Comments:

An unannounced complaint investigation was conducted at the facility on March 14, 2022 by licensing staff from 9:49 a.m. to 10:13 a.m. in regards to resident receiving services. There were 11 residents in care. Resident records were reviewed and staff interview conducted. The Licensee/Administrator was present for the duration of the inspection. Any violations not related to the complaint but identified during the course of the investigation can be found on the violation notice. Thank you for your cooperation during this inspection. I can be reached at alex.poulter@dss.virginia.gov or 804-662-9771.

Violations:

Standard #:	22VAC40-73-100-A
Complaint related:	No
Description:	Based on interview with staff, the facility failed to develop and implement an infection control program addressing the surveillance, prevention, and control of disease and infection that is consistent with the federal Centers for Disease Control and Prevention (CDC) guidelines. Evidence: 1. During onsite inspection on 3-14-2022, Staff #1 was not wearing a mask during the inspection. Additionally, when asked for the facility?s infection control program regarding COVID-19, Staff #1 stated it was not updated with COVID-19 information. 2. The CDC website updated 2-2-2022 under ?Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic? read, ?Implement Source Control Measures ?Source control refers to use of respirators or well-fitting facemasks or cloth masks to cover a person?s mouth and nose to prevent spread of respiratory secretions when they are breathing, talking, sneezing, or coughing.? 3. Staff #1 confirmed the facility did not develop and implement the infection control program to address CDC guidelines.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-450-C
Complaint related:	No
Description:	Based on record review and interview with staff, the facility failed to ensure the comprehensive individualized service plan (ISP) included the date of identified needs and time frame for expected outcomes. Evidence: 1. Resident #1 admitted 11-28-2020. Resident #1?s comprehensive ISP dated 1-08-2021 did not have date of identified needs and time frame for expected outcomes for 12 out of 12 needs identified on the resident?s ISP. 2. Resident #2 admitted 1-23-2012. Resident #2?s comprehensive ISP dated 7-21-2021 did not have time frame for expected outcomes for ten out of ten identified needs on the resident?s ISP. 3. Staff #1 confirmed during interview Resident #1 and Resident #2?s ISPs did not document the aforementioned information.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-450-F
Complaint related:	No
Description:	Based on record review and interview with staff, the facility failed to ensure individualized service plans (ISPs) were reviewed and updated at least once every 12 months. Evidence: 1. Resident #1 admitted 11-28-2020. Resident #1 did not have an ISP that had reviewed and updated annually. Resident #1?s most current ISP on file was dated and signed 1-08-2021. 2. Staff #1 acknowledged Resident #1?s ISP had not been reviewed and updated at least once every 12 months.
Plan of Correction:	Not available online. Contact Inspector for more information.