VIRGINIA DEPARTMENT OF SOCIAL SERVICES

The Lodge at Old Trail
330 Claremont Lane
Crozet, VA 22932
(434) 823-9100

Current Inspector: Kimberly Davis (804) 662-7578

Inspection Date: July 23, 2024

Complaint Related: No

Areas Reviewed:

22VAC40-73 PERSONNEL 22VAC40-73 RESIDENT CARE AND RELATED SERVICES

Comments:

Type of inspection: Monitoring Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 7-23-24 from 9:49 a.m.-10:30 a.m. The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. A self-reported incident was received by VDSS Division of Licensing regarding allegations in the area(s) of: resident care. Number of residents present at the facility at the beginning of the inspection: 62 Number of resident records reviewed: 1 Number of staff records reviewed: 1 Number of interviews conducted with staff: 2 An exit meeting was conducted to review the inspection findings. The evidence gathered during the investigation supported the self-report of non-compliance with standard(s) or law, and violation(s) were issued. Any violation(s) not related to the self-report but identified during the course of the investigation can also 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, Licensing Inspector at (804) 662-7578 or by email at Kimberly.M.Davis@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-680-D
Description:	Based on a self-report received from the facility as well as staff interviews, the facility failed to ensure that medications shall be administered in accordance with the physician's or other prescriber?s instructions. Evidence: -The record for Resident # 1 contained physician?s orders for the month of November 2023 that noted ? Lispro Insulin 100u/ML Inject subcutaneously per sliding scale before meals.? -The record for Resident # 2 contained physician?s orders for ?Lispro Insulin per sliding scale? (via pen). -Per the self-report from the facility as well as interviews with Staff # 1 and Staff # 2, on 11-18-23 the Medication Aide administered the insulin of Resident # 2 which was in an insulin pen, to Resident # 1, instead of Resident # 1?s insulin vial.
Plan of Correction:	Not available online. Contact Inspector for more information.