VIRGINIA DEPARTMENT OF SOCIAL SERVICES

The Haven Assisted Living @ Studley
7436 Studley Road
Mechanicsville, VA 23116
(804) 779-4847

Current Inspector: Kimberly Davis (804) 662-7578

Inspection Date: Jan. 25, 2022

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES 22VAC40-73 STAFFING AND SUPERVISION 22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-73 BUILDING AND GROUNDS 22VAC40-73 EMERGENCY PREPAREDNESS

Comments:

An unannounced visit was conducted by licensing staff and a Hanover County Sheriff?s Office Investigator on January 25, 2022 to investigate a complaint received regarding resident care and supervision. A census of 5 residents was reported. Resident records and facility documentation were reviewed. Staff interviews were conducted and a tour of the facility was completed. The evidence gathered during the investigation supported the allegation(s) of non-compliance with standards or law, and violations were issued. Any violations not related to the complaint but identified during the course of the investigation can be found on the violation notice. The violations cited are identified in this report. Please complete the "plan of correction" and "date to be corrected" for each violation cited on the violation notice and return it to the licensing office within 10 calendar days. Please specify how the violation will be corrected. The plan must contain: 1) step(s) to correct the non-compliance with the standard(s), 2) measures to prevent the non-compliance from occurring again; and 3) person(s) responsible for implementing each step and/or monitoring any preventative measure(s). Thank you for your cooperation during this inspection. I can be reached at Kimberly.M.Davis@dss.virginia.gov or (804) 662-7578.

Violations:

Standard #:	22VAC40-73-100-A
Complaint related:	No
Description:	Based on a review of the facility?s Addendum: Infection Control Program COVID 19 Procedure/Infection control procedure, the facility failed to implement their infection control program. Evidence: 1. The facility?s Addendum: Infection Control Program COVID 19 Procedure/Infection control procedure, states that ?Visitors are to fill out a screening questionnaire that is related to COVID exposure or susceptibility?. However, during the 01/25/2022 on-site inspection, facility staff did not have licensing staff complete a screening questionnaire nor did facility staff ask licensing staff any screening questions. 2. The same document also states, ?We ask that anyone who enters the facility to come in the front door to have temperatures checked.? Only one of three individuals that entered the facility for the inspection had a temperature taken as the staff member could not get the thermometer to work to conduct the remaining two temperature checks.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-70-A
Complaint related:	No
Description:	Based on a review of documentation the facility failed to report to the regional licensing office within 24 hours any major incident that has negatively affected or that negatively threatened the life, health, safety, or welfare of any resident. Evidence: 1. The licensing office became aware of an incident that occurred on 11/2/2021 that resulted in the death of Resident #1 through notification by an outside agency on 11/30/2021. 2. The facility did not report this incident to the licensing office.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-280-D
Complaint related:	Yes
Description:	Based on staff interviews the facility failed to ensure that at least one direct care staff was awake and on duty at all times in each building when at least one resident is present. Evidence: 1. When interviewed by licensing staff, Staff # 1 and Staff # 2 stated that no staff stay awake all night. 2. Staff #4 stated that they had fewer than 19 residents so they did not need to have a staff member awake at night. However, that particular standard only applies to facilities licensed as residential only.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-290-A
Complaint related:	No
Description:	Based on a review of facility documentation, the facility failed to ensure that it maintained a work schedule that included the names and job classifications of all staff working each shift, with an indication of whomever is in charge at any given time. Evidence: 1. Facility staff provided licensing staff with a sheet with the heading "Staff Information Sheet/Monthly Schedule (including weekends) Month of November 2021 " that listed names of the administrator, manager, primary care staff, and medication aid. 2. The sheet noted "Primary Care Staff 9 a.m.- 9a.m. (live-in)" and included the names of the caregiving staff and medication aid but did not include the dates worked for each staff member. 3. This same document notes, ?When administrator and manager are not on premises person in charge is live in care staff.? Staff #1 and #2 are both live in care staff. The Monthly Schedule did not indicate which live in care staff was in charge for any day of the week for November 2021. Photograph evidence was taken.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-300-B
Complaint related:	No
Description:	Based on a review of facility documentation the facility failed to ensure that written communication was utilized as a means of keeping direct care staff on all shifts informed of significant happenings or problems experienced by residents, including complaints and incidents or injuries related to physical or mental conditions. Evidence: The facility did not have communication log notes for 11-2-2021 regarding the incident that resulted in the death of Resident # 1. Facility staff stated that noted for that day could not be found during the inspection. The facility was informed that the communication log notes for 11-2-2021 could be faxed to the licensing inspector if located but it was not received and Staff # emailed the licensing inspector on 1-26-22 and stated that the facility did not have notes for that date.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-450-C
Complaint related:	No
Description:	450.C Based on a review of resident records the facility failed to ensure that the Individualized Service Plan (ISP) included a description of needs based upon the Uniform Assessment Instrument (UAI). Evidence: The UAI (dated 3-1-21) for Resident # 1 (admit date: 2-1-21) has a check mark indicating ?No? for Needs Help with Eating/Feeding, however, the resident?s ISP (dated 3-1-21) states, ?Requires assistance with eating/ feeding? under Description of Needs and also states, ?Resident will be assisted with eating/feeding during all meals as needed? under the Description of Services to be Provided. Photograph evidence was taken.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-460-A
Complaint related:	No
Description:	Based on a review of facility documentation, interviews conducted with facility staff, and information obtained from collateral contacts, the facility failed to assume general responsibility for the health, safety, and well-being of the residents. Evidence: 1. On 12/7/2021, the licensing office was contacted from a collateral contact to report a suspicious death of a resident that occurred on 11/2/2021. 2. Based on information received through the collateral contact, Resident #1 was found deceased by a staff member with a piece of furniture on top of her head and throat. 3. Based on interviews with Staff #1, Staff #2, and the collateral contact, Resident #1 was found unresponsive, deceased, and cold to the touch.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-860-I
Complaint related:	No
Description:	Based on a tour of the facility the facility failed to ensure that it stored cleaning supplies and other hazardous materials in a locked area. Evidence: Licensing staff observed a bottle of Lysol all-purpose cleaner on the bathroom sink in the room that Resident # 1 formerly lived in. The resident room and bathroom were accessible to all residents in the facility, including those residents with the dementia diagnoses. Photograph evidence was taken.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-870-E
Complaint related:	No
Description:	Based on a tour of the facility the facility failed to ensure that all furnishings, fixtures, and equipment, including window coverings, shall be kept clean and in good repair and condition. Evidence: Licensing staff observed that the outside of the window in Room #1 was not clean and contained cob webs and insects. Photograph evidence was taken.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-930-A
Complaint related:	No
Description:	Based on staff interviews and a tour of the facility, the facility failed to ensure that a signaling device is easily accessible to the resident in his bedroom or connecting bathroom that alerts the direct care staff that the resident need assistance. Evidence: Staff stated that each resident room used to have a baby monitor, but licensing staff observed that there were no baby monitors or other signaling systems in any resident rooms during a tour of the facility. Staff showed licensing staff a new baby monitor that was still in its packaging. Staff also stated that residents will sometimes ?yell for help? if they need something.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-930-C
Complaint related:	No
Description:	Based on interviews with staff, the facility failed to ensure that direct care staff made rounds at least once each hour to monitor for emergencies or other unanticipated resident needs in buildings licensed to care for 19 or fewer residents under one roof, if the signaling device does not permit staff to determine the origin of the signal to include a written log showing the date and time rounds were made and the signature of the direct care staff member who made rounds. Evidence: 1. Facility staff #1 and #2 stated that they do not remain awake throughout the night. 2. The facility staff did not provide rounds logs upon request stating that they do not complete them. 3. The facility staff stated that ?residents yell for help? if they need something.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-950-A
Complaint related:	No
Description:	Based on a review of the facility documentation and interviews with staff, the facility failed to follow its written emergency response procedures addressing alerting emergency personnel and facility staff. Evidence: 1. The first bullet under the facility?s Emergency Preparedness and Response Plan for Procedure Title: Summoning Help notes ?When it is apparent that a resident is in need of medical help, The caregiver on duty will: Notify 911 emergency services.? 2. Staff #1 stated that she contacted staff #2 (live-in care staff) and that staff #2 called the office. Staff #1 and staff #2 could not recall which one called 911 but noted that the office was called prior to calling emergency services. ?Notify the Administrator? is listed as the fourth bullet in the same document.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-950-H
Complaint related:	No
Description:	Based on a review of the facility?s Emergency Preparedness and Response Plan the facility failed to include all required components in the plan. Evidence: The facility?s Emergency Preparedness and Response Plan did not include that after the emergency the facility shall report the emergency to the regional licensing office by the next day as specified in 22VAC40-73-70.
Plan of Correction:	Not available online. Contact Inspector for more information.