VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Spring Oak Assisted Living at Petersburg
590 Flank Road
Petersburg, VA 23805
(804) 861-6977

Current Inspector: Tamara Watkins (804) 662-7422

Inspection Date: Nov. 5, 2019

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 ACCOMODATIONS AND RELATED PROVISIONS 22VAC40-73 BUILDING AND GROUNDS 22VAC40-73 EMERGENCY PREPAREDNESS 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS Article 1 Subjectivity 32.1 Reported by persons other than physicians 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 22VAC40-80 THE LICENSE. 22VAC40-80 THE LICENSING PROCESS. 22VAC40-80 SANCTIONS.

Comments:

An unannounced renewal inspection was conducted at the facility on 11/05/2019 from approximately 1:00 pm to 4:15 pm. The facility reported a total of 27 residents in care, which includes a secure memory care unit with fourteen (14) residents. Licensing staff reviewed six (6) resident and three (3) staff files along with other required program documentation for compliance. An inspection of the interior and exterior of the building was also completed. Areas of non-compliance found are identified in the Violation Notice. The facility has 10 calendar days from receipt of the inspection reports to complete a plan of correction, sign the inspection reports and return them to the licensing office. A copy of the inspection reports shall be retained to be posted at the facility. Results of the inspection are subject to public disclosure and will be posted on the VDSS website within 15 calendar, regardless of whether the plan of correction is completed. The plan of correction shall include the following: (1) Step(s) the facility will take to correct the violations cited; (2) Measures that will be put in place to prevent recurrence of each violation; (3) Person(s) responsible for implementation and monitoring of preventive measures; and (4) Date by which each violation will be corrected.

Violations:

Standard #:	22VAC40-73-440-A
Description:	Based on a review of resident records the facility failed to complete a Uniform Assessment Instrument prior to the residents admission. Evidence: Resident #2 has a documented date of admission to the facility on 8/26/19 but his UAI was not completed until 8/27/19. Resident #4 has a documented date of admission to the facility as 9/24/19 but the UAI was not completed until 9/25/19.
Plan of Correction:	The DON will ensure that all uniform assessments are done during the initial assessment. Administrator, RCC and/or DON will review all new admission paperwork and ensure UAI is completed prior to admitting resident. This will be an on-going process.We are unable to correct this one but will ensure that future admits are correctly completed.
Standard #:	22VAC40-73-450-A
Description:	Based on a review of resident records the facility failed to complete a preliminary Individual Service Plan on or within seven days prior to the day of the residents admission. Evidence: Resident #2 has a documented date of admission to the facility as 8/26/19 but the preliminary service plan was not completed until 8/27/19. Resident #4 has a documented date of admission to the facility as 9/24/19 but the preliminary service plan was not completed until 9/25/19.
Plan of Correction:	The DON will ensure that all preliminary plans of care are done during the initial assessment. Administrator, RCC and/or DON will review all new admission paperwork and ensure the ISP is completed prior to admitting resident. This will be an on-going process.We are unable to correct this one but will ensure that future admits are correctly completed.