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

Current Inspector: Tamara Watkins (804) 662-7422

Inspection Date: Sept. 21, 2022

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
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 COMPLAINT INVESTIGATION
22VAC40-80 SANCTIONS

Comments:
Type of inspection: Renewal
Date(s) of inspection 9/21/2022 from 11:00a -5:00p. The licensing inspector was on-site at the facility for each day of the inspection:
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: 7
Number of staff records reviewed: 5
Number of interviews conducted with residents: 3
Number of interviews conducted with staff: 2
Observations by licensing inspector: Resident bedrooms, common areas, lunch, staff resident interactions.
Additional Comments/Discussion:
An exit meeting will be conducted to review the inspection findings.

The evidence gathered during the renewal inspection determined non-compliance with applicable standard(s) or law, and violation(s) were documented on the violation notice issued to the facility. The applicant has the opportunity to submit a plan of correction to indicate how the cited violation(s) will be addressed in order to maintain future compliance with applicable standard(s) or law.

If the applicant 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 should the facility be issued a license to operate.

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 a licensed facility.

For more information about the VDSS Licensing Programs, please visit: www.dss.virginia.gov

Should you have any questions, please contact Tamara Watkins, Licensing Inspector at (804) 662-7422 or by email at tamara.g.watkins@dss.virginia.gov

Violation Notice Issued: Yes

Violations:
Standard #: 22VAC40-73-1100-A
Description: Based on a review of resident records the facility failed to obtain approval prior to placement of a resident in a safe secure environment.
Evidence:
Written approval for placement in the secure unit was not maintained in the resident record for resident #1.

Plan of Correction: Not available online. Contact Inspector for more information.

Standard #: 22VAC40-73-120-A
Description: Based on a review of staff records the facility failed to ensure that orientation and training occurred within seven days of employment.
Evidence:
No orientation was maintained in the staff record for Staff #2 employed on 8/23/22; Staff #3 employed 9/4/22; and Staff #4 employed 8/24/2022.

Plan of Correction: Not available online. Contact Inspector for more information.

Standard #: 22VAC40-73-250-D
Description: Based on a review of staff records the facility failed to maintain and include in the staff record for each person an initial tuberculosis risk assessment.
Evidence:
There was no initial tuberculosis risk assessment maintained in the staff record for Staff #3,4,5.

Plan of Correction: Not available online. Contact Inspector for more information.

Standard #: 22VAC40-73-440-A
Description: Based on a review of resident records the facility failed to complete an annual uniform assessment instrument for all residents.
Evidence:
Resident #1 was admitted to the facility on 4/8/2019 the last UAI was completed on 4/8/2021; Resident #6 was admitted to the facility on 7/31/2020 the last UAI was completed on 7/16/2021.

Plan of Correction: Not available online. Contact Inspector for more information.

Standard #: 22VAC40-73-450-F
Description: Based on a review of resident records the facility failed to ensure that individualized service plans are reviewed and updated every 12 months.
Evidence:
Resident #1 was admitted to the facility on 4/8/2019 the last ISP in the resident record is dated 4/8/2021. Resident #6 was admitted to the facility on 7/31/20 the last ISP in the resident record is dated 7/16/2021.

Plan of Correction: Not available online. Contact Inspector for more information.

Standard #: 22VAC40-73-550-G
Description: Based on a review of resident and staff records the facility failed to review annually with each resident or staff person the rights and responsibilities of residents in an assisted living facility.
Evidence:
The last rights review documented for Resident#1 is 7/20/2020; Resident #3 is 7/12/2020; Resident #6 is 7/31/2020.
The last rights review documented for Staff #1 is dated 2019. No rights review was documented for Staff# 2,3,4,5.

Plan of Correction: Not available online. Contact Inspector for more information.

Disclaimer:
This information is provided by the Virginia Department of Social Services, which neither endorses any facility nor guarantees that the information is complete. It should not be used as the sole source in evaluating and/or selecting a facility.

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