VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Dogwood Crossing Senior Living And Memory Care
130 Deer Ridge Trail
Tazewell, VA 24651
(276) 385-7150

Current Inspector: Rebecca Berry (276) 608-3514

Inspection Date: June 11, 2024 and June 13, 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 EMERGENCY PREPAREDNESS 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS 22VAC40-90 THE SWORN STATEMENT OR AFFIRMATION 22VAC40-90 THE CRIMINAL HISTORY RECORD REPORT

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: 06/11/2024 10:30am to 3:27pm and 06/13/2024 9:55am to 2:23pm 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: 42 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 5 Number of staff records reviewed: 3 Number of interviews conducted with residents: 2 Number of interviews conducted with staff: 3 Observations by licensing inspector: 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 Becky Berry, Licensing Inspector at 276-608-3514 or by email at rebecca.berry@dss.virginia.gov.

Violations:

Standard #:	22VAC40-73-450-C
Description:	Based on a review of resident records, the facility failed to address all identified needs on the comprehensive individualized service plan (ISP) for three of the resident records reviewed. EVIDENCE: 1. The Uniform Assessment Instrument (UAI) for resident #2 dated 05/13/2024 and 06/10/2024 describes the following behavior: ?Public display of inappropriate sexual behaviors.? This behavior was noted on the comprehensive ISP dated 05/14/2024, but there was no description of services to be provided, frequency of service and service to be performed, expected outcomes and tine frames, and persons who will provide services. 2. The UAI for resident #3 dated 04/23/2024 identifies a behavior pattern of Wandering/Passive ? Weekly or more; this need was not addressed on the comprehensive ISP for resident #3 dated 05/14/2024. 3. The UAI for resident #4 dated 12/15/2024 describes the following behavior: ?Frequently tries to walk out secured unit doors; barricades bedroom doors with furniture.? These behaviors were noted on the ISP for resident #4 dated 02/05/2024, but there was no description of services to be provided or frequency of service and service performed.
Plan of Correction:	Resident #2 ISP will be updated with description of services to be provided, frequency of service and service to be performed, expected outcomes and tine frames, and persons who will provide services. Resident #3 ISP will be updated to identify behavior pattern of Wandering/Passive ? Weekly or more Resident #4 ISP will be updated with description of services to be provided, frequency of service and service performed. All ISP?s will be completed based on the current UAI identified needs Administrator and/or RCD will monitor for compliance. [SIC]
Standard #:	22VAC40-73-750-B
Description:	Based on observations made during a tour of the building, the facility failed to ensure each bedroom shall contain all required items, including a sturdy chair for each resident. EVIDENCE: 1. Resident rooms #209, #104 and #109 were assigned two residents; there was only one sturdy chair observed in each of those rooms. 2. Resident room #110 was assigned one resident; there were no chairs observed in the room.
Plan of Correction:	Residents? rooms #209, #104, #109 and #110 will contain a sturdy chair. Housekeeping and Maintenance will monitor resident?s rooms Administrator will monitor for compliance [SIC]
Standard #:	22VAC40-73-860-G
Description:	Based on observations made during a tour of the building, the facility failed to ensure hot water at taps available to residents shall be maintained within a range of 105?F to 120?F. EVIDENCE: 1. In resident room #205, the hot water at the sink reached a temperature of only 94 degrees Fahrenheit.
Plan of Correction:	Maintenance staff will monitor hot water tap temperature in Room #205 daily and include random other rooms on unit daily for 30 days to ensure hot water temp is between range of 105-120 degrees Fahrenheit. Administrator will monitor for compliance [SIC]
Standard #:	22VAC40-73-870-A
Description:	Based on observations made during a tour of the building, the facility failed to ensure the interior and exterior of all buildings shall be maintained in good repair and kept clean and free of rubbish. EVIDENCE: 1. A small stain was observed on the carpet in resident room #300 in front of the closets, covering an area of approximately 3 by 5 inches. 2. A small dark stain was observed on the carpet in resident room #304 on the left by the baseboard next to the entrance, covering an area of approximately 3 by 4 inches.
Plan of Correction:	Rooms #300 and #304 carpet will be shampooed by housekeeping staff. All residents? room will be evaluated for the need of carpet cleaning. Housekeeping and Maintenance will audit monthly for needs. Administrator will monitor for compliance. [SIC]
Standard #:	22VAC40-73-870-E
Description:	Based on observations made during a tour of the building and grounds, the facility failed to ensure all furnishings, fixtures, and equipment shall be kept in good repair and condition. EVIDENCE: 1. In the enclosed outdoor area by the sitting room at end of the special care unit, a portion of the black chain link fence that joins the black aluminum fence had separated from the post, leaving a gap of approximately 10-12 inches of open space.
Plan of Correction:	The fence will be assess for the need of repair. Fence was repaired on 6/14/2024 Maintenance will do audit weekly for needs. Administrator will monitor for compliance [SIC]