VIRGINIA DEPARTMENT OF SOCIAL SERVICES

The Devonshire
2220 Executive Drive
Hampton, VA 23666
(757) 827-7100

Current Inspector: Darunda Flint (757) 807-9731

Inspection Date: March 13, 2024 and March 25, 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 BUILDINGS AND GROUND 22VAC40-73 EMERGENCY PREPAREDNESS 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: Renewal Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 03/13/2024 (arrival 8:46 am / departure approximately 5:00 pm) and 03/25/2024 (arrival 9:02 am/ departure 3:00pm) 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: 34 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 6 Number of staff records reviewed: 3 Number of interviews conducted with residents: 3 Number of interviews conducted with staff: 2 Observations by licensing inspector: Breakfast and an activity were observed. A medication pass observation was completed for 4 residents. The following were reviewed: resident and staff records, medication cart, fire inspection report, health inspection report, water temperatures, and the staff schedule. 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 Darunda Alexander Flint, Licensing Inspector at (757) 807-9731or by email at darunda.a.flint@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-210-B
Description:	Based on staff record review the facility failed to ensure in a facility licensed for both residential and assisted living care, all direct care staff shall attend at least 18 hours of training annually. Evidence 1.The record for staff #1 contained 14 hours of training. Staff #1?s record did not contain 18 hours of annual training.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-320-A
Description:	Based on record review, the facility failed to ensure a risk assessment for tuberculosis (TB) be completed within the 30 days preceding admission for a person. Evidence 1.Resident #2?s record included a TB risk assessment that did not provide documentation of the assessment date. The assessment date section on the form was blank. 2.Staff #4 acknowledged the aforementioned residents record did not provide the TB risk assessment date.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-860-G
Description:	Based on observation and staff interviewed, the facility failed to ensure the hot water at taps available to residents shall be maintained in a range of 105 degrees Fahrenheit (F)( to 120 degrees F. Evidence 1. On 03/13/2024, during a tour of the facility with staff #10, the hot water temperature was checked in room #168. The temperature reading was 120.6 degrees F. 2. The hot water temperature was checked in room #193. The hot water temperature reading was 120.9 degrees F. 3. Staff #10 acknowledge the aforementioned hot water temperature readings.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-870-A
Description:	Based on observation, 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. On 03/25/2024 during a tour of the facility, the patio door screen, located in the resident dining area, was observed to be torn. 2. Three empty wire tomato plant cages were laying on the ground in the patio area courtyard. 3. Staff #6 acknowledged the aforementioned three empty wire tomato plant cages laying on the ground and the torn patio door screen
Plan of Correction:	Not available online. Contact Inspector for more information.