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: Aug. 29, 2022

Complaint Related: Yes

Areas Reviewed:

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 ARTICLE 2 ? SUBJECTIVITY

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: 8/29/22 The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. A complaint was received by VDSS Division of Licensing on 8/16/22 regarding allegations in the area(s) of: Part IV. Staffing and supervision; VI. Resident care and related services; Part VIII. Buildings and Grounds Number of residents present at the facility at the beginning of the inspection: 94 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 3 Number of staff records reviewed: 4 Number of interviews conducted with residents: 2 Number of interviews conducted with staff: 3 Observations by licensing inspector: Dining room, water temperatures, bathrooms, residents? rooms, kitchen, medication administration records, and physician?s orders, resident and staff records were all observed reviewed. An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation did not support the allegation(s) of non-compliance with standard(s) or law. However, violation(s) not related to the complaint(s) 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 Alyshia Walker, Licensing Inspector at (757)670-0504 or by email at Alyshia.Walker@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-1180-B
Complaint related:	No
Description:	Based upon observation during facility tour and discussion with staff, the facility failed to ensure that ordinary materials or objects that are harmful to resident be inaccessible to the residents except under staff supervision. Evidence: 1. On August 29, 2022, during an inspection of the facility, bleach was left unattended in dining area. 2. On this same date, the facility?s maintenance and employee?s room were left unlocked. Both rooms contained jars of paint and paint supplies.
Plan of Correction:	Kitchen staff in-serviced on sanitizing dining room and securing cleaning products after use. All cleaning products, paint and paint supplies will be stored in locked area.
Standard #:	22VAC40-73-40-B-4
Complaint related:	No
Description:	Based on observation, the facility failed to ensure certain documents related to the terms of the license were posted on the premises of thelicensed facility, including the most recently issued license and the findings of the most recent inspection of the facility. Evidence: During the on-site inspection on 8/29/22, the most recent findings from the inspection dated 12/09/2021 were not posted.
Plan of Correction:	Administrator will ensure that most recent on-site inspection with findings is posted at the entrance with our DSS AL license.
Standard #:	22VAC40-73-290-B
Complaint related:	No
Description:	Based on an inspection of the facility on 8/29/22, the facility failed to ensure the posting of the name of the current on-site person in charge as required. Evidence: On 8/29/22 the name of the staff person in charge was Staff #1, who was not in the building during the inspection.
Plan of Correction:	Administrator will post the Weekly Designated Person in Charge in the front entrance.
Standard #:	22VAC40-73-610-B
Complaint related:	No
Description:	Based upon observation during the facility tour and discussion with staff, the facility failed to post a current menu which included snacks in an area that is conspicuous to residents. Evidence : 1. On 8/29/22, during the on-site inspection of the facility, the menu posted was for the previous day 8/28/22 and did not list snacks. 2. Staff#4 acknowledged that the menu was not current and there was no snack listed.
Plan of Correction:	Facility will maintain and post a 4-week Menu cycle including snacks available and will note any substitutions.
Standard #:	22VAC40-73-780-B
Complaint related:	No
Description:	Based upon observation and discussion with staff, the facility failed to ensure the building shall be free from foul, stale , and musty odors Evidence: Inspector noticed a strong urine odor located on the south hall of the facility.
Plan of Correction:	Soiled residents will be changed immediately. Soiled pullups/ diapers to be doubled bagged and placed in dumpster. Housekeeping/Nursing to disinfect room afterwards.
Standard #:	22VAC40-73-870-A
Complaint related:	No
Description:	Based upon observation and discussion with staff, the facility failed to ensure that the interior and exterior of all buildings shall be maintained in good repair and kept clean and free of rubbish. Evidence: 1. In the south bathroom, there were tiles missing on the tub and paint peeling on the walls. 2. In one of the bathrooms located on the east hall, there were used wet towels and bath cloths on the floor. 3. In the same bathroom, the floors were slippery and muddy.
Plan of Correction:	Tiles were replaced in the South Wing Bathroom. Peeling paint will be removed and repainted. Nursing, housekeeping and administration staff to check bathrooms for wet linens and safety.
Standard #:	22VAC40-73-890-B
Complaint related:	No
Description:	Based upon observation during facility tour and discussion with staff, the facility failed to ensure that all interior and exterior areas shall be adequately lighted for the safety and comfort of residents and staff. Evidence: 1. There was one blown light bulb located on the south hall and one light blown inside of the bathroom located on the south hall. 2. On the same hall there were light bulbs that were flickering.
Plan of Correction:	Administrator and Maintenance Coordinator will make daily rounds and replace any burnt out light bulbs.