VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Commonwealth Senior Living At Charlottesville
1550 Pantops Mountain Place
Charlottesville, VA 22911
(434) 977-4094

Current Inspector: Coy Stevenson (804) 972-4700

Inspection Date: Feb. 23, 2024

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 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS 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

Comments:

Type of inspection: Renewal Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: An on-site inspection on February 23, 2024. The Licensing Inspectors were on-site between 10:35 AM ? 2:15 PM 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: At the time of the on-site review, Thirty-One clients were residing in the assisted living wing of the facility and Twenty-Seven clients were residing in the memory care wing of the facility. The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: Five records of clients residing in the assisted living wing of the facility, and five records of clients residing in the memory care wing of the facility were reviewed. Number of staff records reviewed: Five records of employees working with clients residing in the assisted living wing of the facility, and five records of employees working with clients residing in the memory care wing of the facility were reviewed. Number of interviews conducted with residents: Four residents were interviewed during the on-site review. Number of interviews conducted with staff: Four employees were interviewed during the on-site review. Observations by licensing inspector: Observations of meal service, medication administration, client bedrooms and common areas, private and public restrooms, and areas of food preparation areas were noted. 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. For more information about the VDSS Licensing Programs, please visit: www.dss.virginia.gov Should you have any questions, please contact Coy Stevenson, Licensing Inspector at 804-972-4700 or by email at coy.stevenson@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-320-A
Description:
Plan of Correction:	Residents? charts have been audited and reviewed to ensure compliance. Annual Tuberculosis screening will be conducted by licensed staff. This process will be managed by the Resident Care Director and monitored by the Executive Director to ensure community is within compliance. Upon admission licensed staff will thoroughly review resident charts to ensure a negative tuberculosis test is obtained within thirty days preceding admission.
Standard #:	22VAC40-73-330-B
Description:
Plan of Correction:	Residents? charts have been audited, reviewed and violation corrected. Audit will be completed of current resident files and annual TB screening will be updated as appropriate to assure continued regulatory compliance. Annual Tuberculosis screening will be conducted by licensed staff, this process will be managed by the Resident Care Director & monitored Executive Director
Standard #:	22VAC40-73-720-A
Description:
Plan of Correction:	Residents? charts have been audited and reviewed to ensure compliance. 1.) Individualized Service Plan (ISP) reviewed and will be updated including the DNR order to be shown on the ISP. 2.) Individualized Service Plan (ISP) reviewed and will be updated including the DNR order to be shown on the ISP. Charts will be audited on a regular basis by staff that have been appropriately trained in completion of ISPs to ensure that they are current and up to date information is provided and included in the Individualized Service Plans. This process will be managed by the Resident Care Director (RCD) & monitored Executive Director (ED)