VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Waynesboro Manor
809 Hopeman Parkway
Waynesboro, VA 22980
(540) 942-2250

Current Inspector: Jessica Gale (540) 571-0358

Inspection Date: June 11, 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 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

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: 06/11/2024 8:30am ? 3:40pm The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection 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 Jessica Gale, Licensing Inspector at 540-571-0358 or by email at Jessica.gale@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-290-B
Description:	Based on direct observation, the current on-site person in charge was not posted in the facility. Evidence: 1. Two licensing inspectors observed upon entrance to the facility the white board labeled ?Person in charge? that did not include the name of the person in charge. 2. Staff 2 stated ?I didn?t have time to write it?
Plan of Correction:	The Staff in Charge white board currently states Tammy Bare as Staff in Charge. The Registered Medication Aides have all been reminded that when they become Staff in Charge, they are to write their full name on the Staff in Charge white board. All staff have been asked to check the Staff in Charge white board throughout their shifts to ensure the correct name is posted as this white board should never be blank
Standard #:	22VAC40-73-560-E
Description:	Based on direct observation, the facility failed to ensure resident records are kept in a locked area. Evidence: 1.Two licensing inspectors observed during the facility tour the cabinet containing resident records unlocked with the key in the door, inside of an unlocked and unattended office.
Plan of Correction:	The cabinet containing the resident records is currently locked. The key was in the cabinet the date of inspection as the Staff in Charge was covering a call out instead of working in the office, passing medications and had to give access to the Hospice Nurse currently charting her resident visits that morning. Office staff have been reminded to keep the cabinet containing resident charts locked when leaving the office.
Standard #:	22VAC40-73-610-B
Description:	Based on direct observation and staff interview, the facility failed to ensure the weekly menu posting is dated. Evidence: 1. Two licensing inspectors observed during the facility tour, the weekly menu posting that did not include the dates. 2. Staff 1 stated ?we?ve never put the date on them?
Plan of Correction:	The current weekly menu has the week of June 16, 2024 on it. The weekly menus now have a date template printed on them so that each Sunday the Cook can fill in the date for the upcoming week. The Person in Charge each Sunday morning will ensure the date on the menu is filled in.
Standard #:	22VAC40-73-860-I
Description:	Based on direct observation and staff interview, the facility failed to ensure cleaning supplies and other hazardous materials are kept in a locked area. Evidence: 1. The laundry room door in the resident hallway was unlocked and contained 2 large containers of laundry detergent pods. 2. Staff 2 stated ?It doesn?t lock? when asked if the laundry room door was kept locked. 3. Photo evidence taken
Plan of Correction:	The Laundry Room door is currently locked. The door knob to the Laundry Room was replaced during the inspection. All staff have been reminded to keep the Laundry Rooms and cleaning supplies locked up at all times when not in use. Staff in Charge have been asked to check the Laundry Room doors throughout their shifts to ensure doors are locked when not in use. All staff have been reminded to keep cleaning carts within reach when not locked inside the Laundry Rooms