VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Heritage Green Assisted Living
7080 Brooks Farm Road
Mechanicsville, VA 23111
(804) 746-7370

Current Inspector: Shelby Haskins (804) 305-4876

Inspection Date: May 22, 2024

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 PERSONNEL 22VAC40-73 STAFFING AND SUPERVISION 63.2 PROTECTION OF ADULTS AND REPORTING 22VAC40-80 COMPLAINT INVESTIGATION

Comments:

Type of inspection: Complaint Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 05/22/2024 arrival time: 10:15am departure 12:05pm The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. A complaint/self-reported incident) was received by VDSS Division of Licensing on 04/22/2024 regarding allegations in the area(s) of: Personnel, Staffing and Supervision, Resident Care and Related Services, Protection of Adults and Reporting, Complaint Investigation Number of residents present at the facility at the beginning of the inspection: 68 Number of resident records reviewed: 9 Number of interviews conducted with staff: 1 An exit meeting will be conducted to review the inspection findings. 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. The evidence gathered during the investigation did not support the allegation of non-compliance with standard(s) or law. However, violation(s) not related to the complaint but identified during the course of the investigation can 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 Shelby Haskins, Licensing Inspector at (804) 305-4876 or by email at Shelby.Haskins@dss.virginia.gov. Violation Notice Issued: Yes A copy of this document will be sent to the licensee/provider for signature. Inspector Name: Shelby Haskins Date Inspection Summary Issued: 5/31/2024

Violations:

Standard #:	22VAC40-73-680-I
Complaint related:	No
Description:	Based on a review of documentation and interview, it was determined that the facility did not ensure that at the time medication is administered, the facility shall document on the medication administration record (MAR) all medications administered to residents, including over the counter medications and dietary supplements. Evidence: 1. A review of the Medication Administration Record (MAR) for resident #5 for the dates of April 20-31, 2024, did not contain documentation of staff initials to indicate that medication was administered. 2. Staff #1 reviewed the Medication A for resident #5 and confirmed that there were no staff initials or signature to indicate that medication was administered.
Plan of Correction:	Immediate corrective actions Upon review and investigation by Staff #1 on 5/24/2024, it was determined the medication was administered but was not documented. Staff #1 documented on the MAR to correct this omission, as the staff who administered the medication is no longer employed by the community, as of 5.18.24. Additional corrective actions: Staff meetings will be scheduled with all staff who administer medications to review proper administration and documentation procedures on 6.5.2024. The RCD or designee will conduct the training review. Ongoing corrective actions: The Resident Care Director or designee will complete quarterly observations of medication passes each year for each staff member who administers medication. Compliance with medication policies and procedures will be reviewed at Quarterly QA Meetings, to look for patterns or trends.