VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Memory Lane Assisted Living
123 Lakeview Drive
Woodstock, VA 22664
(540) 459-3738

Current Inspector: Sarah Pearson (540) 680-9469

Inspection Date: June 1, 2023

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 ACCOMMODATIONS AND RELATED PROVISIONS 22VAC40-73 BUILDINGS AND GROUND 22VAC40-73 EMERGENCY PREPAREDNESS 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS ARTICLE 1 ? SUBJECTIVITY 32.1 REPORTED BY PERSONS OTHER THAN PHYSICIANS 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 22VAC40-80 THE LICENSE 22VAC40-80 THE LICENSING PROCESS 22VAC40-80 COMPLAINT INVESTIGATION 22VAC40-80 SANCTIONS

Technical Assistance:

Facility requesting activity training information related to approved class. Consistently indicate type of mechanical support on service plans.

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: 6/01/23. The Acknowledgement of Inspection form was signed and left at the facility on the date of the inspection. Number of residents present at the facility at the beginning of the inspection: 21. The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. No issues were identified. The facility was clean and odor free. Housekeeping carts were locked or accompanied. Number of resident records reviewed: 5. Number of staff records reviewed: 6. Number of interviews conducted with residents: 1. Number of interviews conducted with staff: 2. Observations by licensing inspector: Outside inspections were current as were related drills. Postings were as required. In additional to a weekly menu the facility has a daily menu posted for each meal. Residents were observed actively participating in a music activity complete with instruments upon arrival of this inspector. No medication issues were identified, and the cart was clean and organized. The facility is just starting to transition from using only nurses for medication to also utilizing registered medication aides. A review of the schedule indicates staffing is as per the standards. Additional Comments/Discussion: No complaints during this licensing inspection period. Fire ? 4/12/23 Health ? 1/2/23 An exit meeting was conducted to review the inspection findings. The evidence gathered during the inspection determined non-compliance with one applicable standard or law, and the violation was documented on the violation notice issued to the facility. The licensee has the opportunity to submit a plan of correction to indicate how the cited violation will be addressed in order to return the facility to compliance and maintain future compliance with applicable standard 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. Should you have any questions, please contact Sharon DeBoever, Licensing Inspector at (540) 292-5930 or by email at sharon.deboever@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-1140-B
Description:	Based on a review of six staff records, staff A (hired 5/2/22) and C (hired 1/30/23) had not completed their required ten hours of dementia training in the first four months of employment. Staff F hired 3/6/23 has six hours to date. The records for staff B,D and E did not reflect the required 18 hours of annual training based on hire date to anniversary date. All other paperwork was in record as required.
Plan of Correction:	Administrator will work with human resources staff and the Relias system to ensure all new care staff complete the required ten hours of dementia training in the first four months. This includes that staff that assist coming from the nursing home side of the facility. For those staff identified in his notice they receive their additional training immediately. Training records will further be adjusted to reflect annual training as hire date to anniversary date for all staff. The administrator will monitor for correction and future compliance.