VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Indian River Assisted Living
1012 Justis Street
Chesapeake, VA 23325
(757) 523-4659

Current Inspector: Lanesha Allen (757) 715-1499

Inspection Date: Dec. 9, 2021

Complaint Related: No

Areas Reviewed:

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

Comments:

Two Licensing Inspectors with the Division of Licensing, conducted an unannounced, mandated, renewal inspection on 12/09/2021.The Licensing Inspectors reviewed resident and staff records, observed the facility physical plant and reviewed additional facility documentation for compliance. Areas of non-compliance can be found within this violation notice. Please contact the facility Licensing Inspector Kimberly Rodriguez at 757-586-4004 or by email at kimberly.rodriguez@dss.virginia.gov for additional questions or concerns.

Violations:

Standard #:	22VAC40-73-320-B
Description:	Based on resident record review the facility failed to ensure subsequent tuberculosis evaluation were completed annually. Evidence while reviewing resident record #2, the Licensing Inspector observed the residents last evaluation was completed 10/07/2020.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-440-A
Description:	Based on resident record review the facility failed to ensure All residents and applicants to assisted living facilities shall be assessed face to face using the uniform assessment instrument in accordance with Assessment in Assisted Living Facilities (22VAC30-110) at least annually. Evidence: While reviewing resident record # 2, the Licensing Inspector observed the residents Uniform Assessment Instrument was last completed on 12/08/2020
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-450-E
Description:	Based on resident record review, the facility failed to ensure the individualized service plan shall be signed and dated by the resident or his legal representative. Evidence: While reviewing resident record # 2, the Licensing Inspector observed the residents individualize service plan dated 12/09/2020 was not signed by the resident or legal representative.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-870-E
Description:	Based on observation of the facility physical plant the facility failed to ensure, all furnishings, fixtures, and equipment shall be kept clean and in good repair and condition. Evidence: While conducting a tour of the facility physical plant with the facility Administrator the Licensing Inspector the following areas not in good repair as evidenced by photos taken: 1-Broken Floor Tile 2-Broken cabinet door 3-Peeling and cracked cabinets 4- Chipped and peeling wall paint
Plan of Correction:	Not available online. Contact Inspector for more information.