VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Commonwealth Senior Living at Chesterfield
4931 Ridgedale Parkway
Richmond, VA 23234
(804) 271-9787

Current Inspector: Angela Rodgers-Reaves (804) 662-9774

Inspection Date: June 26, 2024

Complaint Related: Yes

Comments:

Type of inspection: Complaint Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: On 06/26/2024 approximate time 9:13a.m-1:53p.m The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. A complaint was received by VDSS Division of Licensing on 06/24/2024 regarding allegations in the area of resident care and related services. Number of residents present at the facility at the beginning of the inspection: 75 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 1 Number of staff records reviewed: N/A Number of interviews conducted with residents: 1 Number of interviews conducted with staff: 2 Observations by licensing inspector: N/A Additional Comments/Discussion: An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation did not support the allegations of non-compliance with standard(s) or law. However, violation(s) not related to the complaint but identified during the course of the investigation can 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 Angela Rodgers-Reaves, Licensing Inspector at (804) 840-0253 or by email at Angela.r.reaves@dss.virginia.gov Violation Notice Issued: Yes

Violations:

Standard #:	22VAC40-73-450-C
Complaint related:	No
Description:	Based on the review of facility records and interviews conducted the facility failed to ensure that the comprehensive individualized service plan for a resident included all of the required elements. Evidence: Resident #1-Date of admission 08/10/2024 the resident?s 11/22/2023 wound care orders document that was submitted for the inspector?s review on 06/26/2024 notes that the facility is to ?use prevalon boots to offset heals with laying in bed?. The resident?s 11/29/2023 ISP that was submitted for the inspector?s review on 06/26/2024 is not documented to identify a written description of what services will be provided to address identified needs and who will provide them.
Plan of Correction:	FACILITY S RESPONSE: "All staff in serviced on application of Prevalon boots and ISP updated"