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: May 13, 2024

Complaint Related: No

Areas Reviewed:

Administration and Administrative Services Personnel Staffing and Supervision Admission, Retention and Discharge of Residents Resident Care and Related Services Resident Accommodations and Related Provisions Building and Grounds Emergency Preparedness Additional Requirements for Facilities that Care for Adults with Cognitive Impairments Background Checks for Assisted Living Facilities Sworn Statement

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: 05/13/2024 The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. Number of residents present at the facility at the beginning of the inspection: 15 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 4 Number of staff records reviewed: 4 Number of interviews conducted with residents: No residents interviews conducted due to limited cognition of residents. Number of interviews conducted with staff: 3 Observations by licensing inspector: Licensing Inspector observed residents participating in activity programs and eating lunch. This LI also observed medication being administered to residents. Additional Comments/Discussion: An exit meeting will be conducted to review the inspection findings. The evidence gathered during the inspection determined non-compliance with applicable standard(s) or law, and violation(s) were 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(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. 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 Sarah Pearson, Licensing Inspector at (540) 680-9469 or by email at sarah.pearson@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-1140-B
Description:	Based on a review of five staff records, and staff interview, the facility failed to ensure within four months of the starting date of employment in the safe, secure environment, direct care staff shall attend 10 hours of training in cognitive impairment. Evidence: 1. Staff #3 (hired 1/17/2023) had completed 4.25 hours of cognitive impairment training as of 5/17/2023. 2. Staff #4 (hired 1/9/2024) had completed 6.5 hours of cognitive impairment training as of 5/9/2024.
Plan of Correction:	1. The staff preceptor will check all current direct care staff of Skyline Terrace and Memory Lane Assisted Living have 10 hours of training in cognitive impairment. 2. The staff preceptor will check all direct care staff of Skyline Terrace and Memory Lane Assisted Living who were employed in the past 4 months to ensure they have the 10 hours of training in cognitive impairment. 3. All new hires of both Skyline Terrace and Memory Lane Assisted Living will be educated on hire by the DRC and HR that 10 hours of training in cognitive impairment is required within the first four months of employment. 4. The staff preceptor will check monthly during the first four month of employment to see the current number of hours the employee has in cognitive impairment. The staff preceptor will inform the DRC/Assisted Living Administrator monthly the number of hours each new employee has completed. 5. The DRC/Assisted Living Administrator will meet with each new employee on their third month of hire. The new employee will be told the number of hours that remain to be completed in the next 30 days. 6. Prior to the end of the fourth month of employment the DRC and HR will confirm all direct care new hires have completed the 10 hours of training in cognitive impairment.