VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Greendale Home
18180 Rich Valley Road
Abingdon, VA 24210
(276) 628-8595

Current Inspector: Rebecca Berry (276) 608-3514

Inspection Date: Aug. 10, 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

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: 08/10/2022 The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. Start 11:00am conclude: 1:30pm 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 Crystal B. Mullins Licensing Inspector at 276-608-1067 or by email at crystal.b.mullins@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-380-A
Description:	Based on resident records, the facility failed to include all of the required information prior to or at the time of admission for a resident on the personal/social data information sheet. EVIDENCE: 1. Resident #2 was admitted to the facility on 02/18/2022 2. The following items were left blank on the personal and social data sheet: interest/hobby; birthplace; advanced directives; legal representative; designated contact; responsible party next of kin; dentist; local department of social services; other agency, and mental health history.
Plan of Correction:	Information was completed on data sheet while inspector was present. Administrator designee will complete all personal and social data sheet when new resident is admitted. DON and Administrator will monitor charts for compliance and completed paperwork. [sic]
Standard #:	22VAC40-73-640-A
Description:	Based on observations made during the medication cart audit, the facility failed to adhere to their medication management plant. EVIDNCE: 1. Resident #1 is prescribed Humalog 100 units Inject SQ per sliding scale prior to meals and before bedtime. There was no open date on the container of insulin.
Plan of Correction:	Dates opened shall be clearly marked on the container by Med Tech when it is opened. DON will check all opened boxes weekly to assure dates opened are on each box. [sic]
Standard #:	22VAC40-73-750-E
Description:	Based on observations made during the tour of the building, the facility failed to have sufficient bed and bath linens in good repair so that residents always have a clean supply. EVIDENCE: 1. Resident Room #23 did not have sheets on either of the beds. 2. Resident Room #27 did not have sheets on the bed.
Plan of Correction:	A sufficient supply of sheets are available at facility, Direct Care Staff change bed lining on shower days for each resident and replace lining as needed. Residents are reminded that lining should be kept on their beds at all times and should ask staff when they are needed. [sic]
Standard #:	22VAC40-73-870-A
Description:	Based on observations made during the tour of the building, the facility ailed to keep the interior and exterior of the building maintained in good repair and condition. EVIDENCE: 1. In Resident Room #27, the ceiling has a large brown water stain on half of the ceiling, located close to the doorway. 2. Bathrooms #15 and #16 both had a toilet with brown/black stains around the toilet bowl area.
Plan of Correction:	All furnishings, fixtures, and equipment, including furniture, window coverings, sinks, toilets, bathtubs, and showers, shall be kept clean and in good repair and condition and not soiled in a manner that presents a health hazard. Maintenance staff shall monitor ceiling tile repair or replace tiles that have been stained. Housekeeping shall keep all toilet bowls cleaned daily. Direct Care Staff will report to administrator when the need of extra cleaning is required to ensure cleanness of facility. [sic]
Standard #:	22VAC40-73-925-B
Description:	Based on observations made during the tour of the building, the facility failed to have an adequate supply of paper towels or an air dryer for hand washing. EVIDENCE: 1. Resident Bathroom #16 did not have paper towels available and did not have an air dryer for hand washing. 2. Bathroom #15 did not have paper towels available and did not have an air dryer for hand washing.
Plan of Correction:	Housekeeping will check all paper towel dispensers for adequate supply of paper towels daily. Maintenance will monitor dispensers every evening before end of shift to assure all dispensers have towels. [sic]