VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Mission House
516 W. Spotswood Trail
Elkton, VA 22827
(540) 298-8917

Current Inspector: Sarah Pearson (540) 680-9469

Inspection Date: Aug. 2, 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 Background Checks for Assisted Living Facilities Sworn Statement

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: 8/2/2024 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: 17 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 3 Number of staff records reviewed: 2 Number of interviews conducted with residents: 1 Number of interviews conducted with staff: 3 Observations by licensing inspector: Licensing Inspector observed resident inside and outside on the porch, participating in activity programs and also eating lunch. This LI 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. 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 #:	22VAC40-73-450-C
Description:	Based on resident record review and staff interview, the facility failed to describe the identified needs of the resident on the Individualized Service Plan. Evidence: 1. Resident 1 and 2?s Individualized Service Plan did not include any information regarding the resident being assessed as a high risk for falls. 2. Resident 1 was assessed as being a high risk for falls on 3/25/2024 and the individualized Service Plan dated 3/26/2024 did not provide any information to prevent falls. 3. Resident 2 was assessed as being a high risk for falls on 12/14/2023 and Individualized Service Plan dated 6/4/2024 did not provide any information to prevent falls.
Plan of Correction:	Service plans will be reviewed and updated for those assessed as being a high risk for falls to include information on how to prevent falls. Administrator assumes responsibility for compliance, now and in the future. Date to be corrected by: August 31, 2024
Standard #:	22VAC40-73-950-E
Description:	Based on staff record review and staff interview, the facility failed to develop and implement an orientation and semi-annual review on the emergency preparedness and response plan for all staff, residents an volunteers. Evidence: 1. There was no current emergency preparedness plan review with the staff on record. 2. Staff 2 stated ?I didn?t do that?.
Plan of Correction:	Administrator will add this review to the training calendar to be developed for all staff and volunteers. Residents will also receive semi-annual review as part of the resident council meetings. Administrator assumes responsibility for compliance. Date to be corrected by: August 31, 2024
Standard #:	22VAC40-73-980-H
Description:	Based on observation and staff interview, the facility failed to ensure the availability of emergency food and drinking water. At least 48 hours of the supply must be on site at any given time. Evidence: Staff 2 stated there was not a 48 hour supply of water on site.
Plan of Correction:	Administrator assumes responsibility for ensuring a 48 hour supply of emergency water will be on site immediately and at any given time. Administrator will assume responsibility for future compliance. Date to be corrected by: Immediately August 26, 2024