VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Golden Years Assisted Living Facility, Inc.
40 Hunt Club Boulevard
Hampton, VA 23666
(757) 825-2425

Current Inspector: Alyshia E Walker (757) 670-0504

Inspection Date: Oct. 12, 2022

Complaint Related: Yes

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 ACCOMMODATIONS AND RELATED PROVISIONS 22VAC40-73 BUILDINGS AND GROUND 22VAC40-80 COMPLAINT INVESTIGATION

Comments:

Type of inspection: Other Self Report Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 10/12/2022 The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. A self-reported incident was received by VDSS Division of Licensing on 09/30/2022 regarding allegations in the area(s) of: Resident Care Number of residents present at the facility at the beginning of the inspection: 83 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: 2 Number of interviews conducted with staff: 2 An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation supported the self-report of non-compliance with standard(s) or law, and violation(s) were issued. Any violation(s) not related to the self-report but identified during the course of the investigation can also 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 Alyshia E. Walker, Licensing Inspector at 757-670-0504 or by email at Alyshia.Walker@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-250-D
Complaint related:	No
Description:	Based on record review, the facility failed to ensure that each staff person submit the results of a tuberculosis (TB) risk assessment on or within seven days prior to the first day of work at the facility. Evidence: The record for Staff # 4 (D.O.H.02/02/2022) did not contain an initial TB risk assessment.
Plan of Correction:	Administrative staff will ensure all required paperwork is in employee file prior to first day of working. AIT will monitor state required paperwork .
Standard #:	22VAC40-73-260-A
Complaint related:	No
Description:	Based on record review, the facility failed to ensure that each all staff maintain current certification in first aid. Evidence: The record for Staff # 3 contained a copy of a first aid card with an expiration date of 7/30/2022.
Plan of Correction:	Administrative staff will continue to schedule trainings for employees to meet required training. CPR/First Aid scheduled 01-25-2023
Standard #:	22VAC40-73-350-B
Complaint related:	No
Description:	Based on record review, the facility failed to ascertain, prior to each resident?s admission whether a potential resident is a registered sex offender. Evidence: Resident #2?s admission date was 6/28/2021 and the sex offender inquiry was completed on 7/1/2021.
Plan of Correction:	Administrative staff will ensure sex offender inquiry is done on all potential residents prior to admission. all resident paperwork has been filed accordingly.
Standard #:	22VAC40-73-430-H-1
Complaint related:	No
Description:	Based on record review the facility failed to complete a discharge statement which contains the information listed in standard to the resident and, as appropriate, his legal representative and designated contact person at the time of discharge. Evidence: The record for Resident #2 did not list the date the discharge statement was provided to the resident and as appropriate, legal representative and designated contact person.
Plan of Correction:	The AIT will oversee resident discharges and ensure discharge information is documented and given to resident and or responsible party.
Standard #:	22VAC40-73-440-A
Complaint related:	No
Description:	Based on review of resident record, the facility failed to ensure that uniform assessment instruments (UAIs) are completed as required. Evidence: 1. Resident # 2?s most recent UAI was incomplete in the areas of activities of daily living.
Plan of Correction:	Administrative Staff will continue to keep UAI?s at the nurse?s station and Administrators office in the event paperwork is misfiled it can be replaced accordingly. Administrative staff will monitor and follow up with Nurses for review of their resident records.
Standard #:	22VAC40-73-440-H
Complaint related:	No
Description:	Based on record review the facility failed to ensure the uniformed assessment instrument (UAI) was reviewed annually. Evidence: 1. The most recent UAI review date for Resident # 3 was 8/1/2021. 2. The most recent UAI review date for Resident # 1 was 2/10/2021.
Plan of Correction:	Administrative Staff will continue to communicate with Hampton APS via e-mail and fax to ensure that UAI reviews are done in a timely manner. Request for updates will remain in the residents file for proof of request until current UAI has been received from APS.
Standard #:	22VAC40-73-450-F
Complaint related:	No
Description:	Based on record review and staff interview, the facility failed to ensure the individualized service plan (ISP) shall be reviewed and updated at least once every 12 months and as needed as the condition of the resident changes. Evidence: 1. Resident #1 `s ISP was last reviewed on 2/1/22 and Resident #3?s ISP was last reviewed on 9/16/2021.
Plan of Correction:	Facility has contracted with a Registered Nurse to assist administrative staff and nurses. Contracted nurse will help with reminders for updates. Contracted nurse will oversight.
Standard #:	22VAC40-73-470-A
Complaint related:	No
Description:	Based on record reviewed and staff interview, the facility failed to ensure, either directly or indirectly, that the health care service needs of a resident was met. Evidence: Resident #1?s physician ordered labs to be done on 8/22/2022. The record did not include documentation these services were performed.
Plan of Correction:	RCC will be responsible for ensuring that results from labs etc, are placed in residents medical folder for follow up.
Standard #:	22VAC40-73-550-C
Complaint related:	No
Description:	Based on document review, interview with APS, the facility failed to ensure that a resident of an assisted living facility had the rights and responsibilities as provided in 63.2-1608 of the Code of Virginia. Evidence: 1. The licensing office received a self-report from Staff #1 on 9/20/2022, informing the agency Resident #3 reported being sexually assaulted by Resident #2. 2. On 10/11/2022, Licensing Inspector (LI) conducted interview with assigned Adult Protective Services worker, Collateral #1. 3. On 10/12/2022, LI conducted on-site inspection and reviewed the facility documentation, ISPs, Shift Communication Log notes, Nurses Notes, etc. 4. Facility Shift Communication Log notes dated 9/13/2022, 9/14/2022, 9/15/2022, 9/16/2022, 9/16/2022, 9/17/2022, and 9/18/2022 document that Resident # 3 informed various staff members of the facility that his roommate Resident #2 was sexually harassing him and making sexual advances towards him. The Shift Communication Log notes further document Resident #3 sleeping in the common areas at night due to reported feelings of being unsafe in his room as Resident #2 was sexually harassing him. 5. The facility did not have any documentation that Resident #3?s reported concerns were addressed.
Plan of Correction:	Administrator will meet with all staff regarding documentation of incidents and reporting to the Administrator. The Assistant Administrator will monitor nurses notes weekly to address any documented concerns with the Administrator for follow up. A MANDITORY Inservice ?RESIDENT RIGHTS? with the Ombudsman will be mandatory will all staff.
Standard #:	22VAC40-73-750-B
Complaint related:	No
Description:	Based on observation, the facility failed to supply a comfortable mattress for each resident. Evidence: The mattress in room #9 (bed next to window) was sunken in.
Plan of Correction:	Mattress has been replaced by maintenance. Dir. Of Operations, AIT and maintenance will do weekly walkthroughs to keep up with routine maintenance. All findings will be documented in maintenance log for request and repair date. Dir. Of Operations will follow up on completed and requested repairs.
Standard #:	22VAC40-73-870-A
Complaint related:	No
Description:	Based on observation, the facility failed to maintain the interior and exterior of the building in good repair and keep it clean and free of rubbish. Evidence: 1. The carpet squares in the dining area near the vending machines were lifting, dirty and out of place. 2. The light bulb was out (above the bed to the left near the door) in room #42. 3. Men?s bathroom caulking in the shower and around toilet was black. 4. The paint on the ceiling in the men?s bathroom ceiling was peeling. 5. Paint on wall in room # 35 is peeling. 6. Rusty planters on the outside deck area.
Plan of Correction:	The carpet squares have been replaced. Light bulb has been replaced. Caulking in men?s bathroom has been re-caulked. Room has been painted. Planters on deck area have been disposed of. The Director of Operations will follow up with maintenance with maintenance log to ensure that maintenance repairs are done in a timely manner. Dir. Of Operations, AIT and maintenance will do weekly walkthroughs.