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. 13, 2022 , Dec. 15, 2022 and Dec. 19, 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 22VAC40-90 BACKGROUND CHECKS FOR ASSISTED LIVING FACILITIES 22VAC40-90 THE SWORN STATEMENT OR AFFIRMATION 22VAC40-90 THE CRIMINAL HISTORY RECORD REPORT

Comments:

Type of inspection: Renewal Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 12/13/2022 from 8:40 am to 4:25 pm, 12/15/2022 from 10:40 am to 1:00 pm, and 12/19/2022 from 11:22 am to 11:50 am. 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: 92 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 5 Number of staff records reviewed: 10 An exit meeting will be conducted to review the inspection findings. 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 M. Tess Pittman, Licensing Inspector at (757) 641-0984 or by email at tess.pittman@dss.virginia.gov.

Violations:

Standard #:	22VAC40-73-1070-B
Description:	Based upon observation, 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. During a tour of the facility on 12/13/2022 and 12/15/2022, the facility?s maintenance closet adjacent to the dining room and employee?s closet on the north hall were left unlocked. Both rooms contained jars of paint, paint supplies, cleaning supplies, and various maintenance equipment.
Plan of Correction:	Hot water tank room will be kept locked and all hazardous and flammable materials were removed.
Standard #:	22VAC40-73-50-B
Description:	Based on record review, the facility failed to retain written acknowledgment of the receipt of the disclosure by the resident or his legal representative. Evidence: 1. Upon review of Resident #4 and Resident #6?s record, there was no written acknowledgment of the receipt of the disclosure by the resident or their legal representatives in the resident's record.
Plan of Correction:	A written acknowledgment of receipt of disclosure will be completed and placed in Resident #4 & Resident #6 each resident?s record.
Standard #:	22VAC40-73-210-B
Description:	Based on record review, the facility failed to ensure in a facility licensed for both residential and assisted living care, all direct care staff attend at least 18 hours of training annually, except for direct care staff who are licensed health care professionals or certified nurse aides shall attend at least 12 hours of annual training. Evidence: 1. Staff #3 had a total of 3.75 hours of training from 10/2021-10/2022.
Plan of Correction:	Administrator & BOM to ensure that staff is completing their mandatory meetings, in-services and Relias. If not completed, staff will be taken off of schedule until completed.
Standard #:	22VAC40-73-250-D
Description:	Based on record review, the facility failed to ensure each staff person or household member required to be evaluated annually submit the results of a risk assessment, documenting that the individual is free of tuberculosis in a communicable form as evidenced by the completion of the current screening form published by the Virginia Department of Health or a form consistent with it. Evidence: 1. The last tuberculosis risk assessment for Staff #4 was completed on 01/28/2021.
Plan of Correction:	No later than August 1st each year all employees (except new hires) will receive a TB screening by one of our house physicians.
Standard #:	22VAC40-73-260-C
Description:	Based on observation and discussion, the facility failed to ensure a listing of all staff who have current certification in first aid or CPR is posted in the facility. Evidence: 1. During the tour of the facility on 12/15/2022, Staff #6 acknowledged a listing of all staff who have current certification in first aid or CPR is not posted in the facility.
Plan of Correction:	Administrator & BOM will post a listing of staff certified in First Aid & CPR and their expiration dates.
Standard #:	22VAC40-73-310-D
Description:	Based on record review, the facility failed to provide written assurance to a resident or the legal representative documenting that the facility has the appropriate license to meet their care needs prior to admission. Evidence: 1. There was no evidence of written assurance to Resident #6 or their legal representative documenting that the facility has the appropriate license to meet their care needs prior to admission.
Plan of Correction:	A written assurance will be received from Resident #6?s guardian and placed in his resident record.
Standard #:	22VAC40-73-350-B
Description:	Based on record review, the facility failed to ascertain, prior to admission, whether a potential resident was a registered sex offender and failed to document that this was ascertained and the date the information was obtained. Evidence: 1. The following residents did not have a completed sex offender screening in their record: Resident #4 (admitted 10/27/2022), Resident #5 (admitted 09/14/2022), and Resident #6 (admitted 01/05/2022).
Plan of Correction:	Sex offender screenings will be redone for Resident #4, Resident #5 and Resident #6. All qualified applicants will be screened for sex offender PRIOR to admission.
Standard #:	22VAC40-73-390-A
Description:	Based on record review, the facility failed to ensure at or prior to the time of admission, there be a written agreement/acknowledgment of notification dated and signed by the resident or applicant for admission or the appropriate legal representative, and by the licensee or administrator. Evidence: 1. The facility was unable to provide documentation there was a written agreement/acknowledgment of notification dated and signed by the appropriate legal representative for Resident #6 (admitted 01/05/2022).
Plan of Correction:	The written agreement will be done on the day of the resident?s admission. Except for JFS guardianship, admission paperwork will be sent to the guardian and signatures will be placed in the new resident?s record.
Standard #:	22VAC40-73-410-A
Description:	Based on record review, the facility failed to ensure upon admission, the assisted living facility provide an orientation for new residents and their legal representatives, including emergency response procedures, mealtimes, and use of the call system. Acknowledgment of having received the orientation shall be signed and dated by the resident and, as appropriate, his legal representative, and such documentation shall be kept in the resident's record. Evidence: 1. The following residents did not have evidence of receiving orientation upon admission: Resident #4 (admitted 10/27/2022) and Resident #6 (admitted 01/05/2022).
Plan of Correction:	On day of admission, the Administrator or RCC will orient new resident to IRAL.
Standard #:	22VAC40-73-550-G
Description:	Based on record review, the facility failed ensure the rights and responsibilities of residents in assisted living facilities be reviewed annually with each resident or his legal representative or responsible individual as stipulated in subsection H of this section. Evidence: 1. The following residents did not have current documentation of an annual review of resident rights and responsibilities: Resident #3, Resident #6, Resident #7, and Resident #8.
Plan of Correction:	The Resident Rights & Responsibilities will be reviewed with new residents and on an annual basis in January and June.
Standard #:	22VAC40-73-610-B
Description:	Based on observation, the facility failed to ensure menus for meals for the current week are dated and posted in an area conspicuous to residents. Evidence: 1. During the tour of the facility on 12/13/2022 and 12/15/2022, the posted menu did not indicate the days date.
Plan of Correction:	A 4-week menu cycle will be posted outside of the Dining Room. Any substitutions will be noted.
Standard #:	22VAC40-73-610-E
Description:	Based on discussion, the facility failed to attain a copy of a diet manual containing acceptable practices and standards for nutrition to be kept current and readily available to personnel responsible for food preparation. Evidence: 1. During the tour of the facility on 12/13/2022, Staff #1 confirmed the facility does not have a copy of a diet manual containing acceptable practices and standards for nutrition.
Plan of Correction:	Will work with Dietician to provide a diet manual.
Standard #:	22VAC40-73-860-G
Description:	Based on observation, the facility failed to ensure hot water at taps available to residents are maintained within a range of 105?F to 120?F. Evidence: 1. During the tour of the facility on 12/13/2022, the hot water taps sampled were not within the required range in the following areas: south hall bathroom measured 128?F and east hall bathroom measured 100?F.
Plan of Correction:	Maintenance Coordinator to check 3 rooms on each wing weekly and adjust the water temps to read between 105F-120F.
Standard #:	22VAC40-73-870-A
Description:	Based upon observation, 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. The south hall bathroom has tiles missing on the tub, paint peeling on the walls, stains to the ceiling, a light out, and rust noted on fixtures. 2. The west hall bathroom has tiles missing on the tub, dirt, dust, and rust noted on fixtures. There were also used wet towels on the floor.
Plan of Correction:	Management staff to patrol campus for trash & daily rounds to note any maintenance concerns.
Standard #:	22VAC40-73-890-B
Description:	Based upon observation, the facility failed to ensure that all interior and exterior areas be adequately lighted for the safety and comfort of residents and staff. Evidence: 1. There were three lights out within the dining room of the facility.
Plan of Correction:	Management staff to conduct daily rounds to check all common areas for light out and any maintenance repairs.
Standard #:	22VAC40-73-980-B
Description:	Based on observation, the facility failed to ensure a first aid kit on the vehicle that is used to transport residents contain items as identified in the standard. Evidence: 1. The vehicle first aid kit did not include adhesive tape, antiseptic wipes/ointment, and a first aid instructional manual.
Plan of Correction:	The van has a new first aid kit with all items mentioned including a first aid instructional manual.
Standard #:	22VAC40-73-990-C
Description:	Based on interview, the facility failed to document staff participation in practice exercises for resident emergencies at least once every six months. Evidence: 1. The facility could not provide documentation that staff had participated in an exercise in which the procedures for resident emergencies were practiced at least every six months.
Plan of Correction:	In January and June staff will participate in a practice exercise for resident emergencies including: missing person, hurricane and tornado drills.
Standard #:	22VAC40-90-40-B
Description:	Based on record review, the facility failed to obtain a criminal history record report on or prior to the 30th day of employment for each employee. Evidence: 1. The following staff did not have a completed criminal history record report in their record: Staff #2 (hired 03/04/2022), Staff #8 (hired 06/16/2022), Staff #9 (hired 09/01/2022), and Staff #10 (hired 06/18/2022).
Plan of Correction:	Criminal history record will be obtained on or prior to the 30th day of employment for a new hire.
Standard #:	22VAC40-90-40-H
Description:	Based on record review, the facility failed ensure any person employed does not have a conviction of any of the barrier crimes. Evidence: 1. Staff #7 was hired on 04/25/2022. A criminal history record report for Staff #7 was completed on 06/21/2022. The criminal history record report indicates Staff #7 was convicted of a felony barrier crime.
Plan of Correction:	Any person who has a conviction of any of the barrier crimes will be terminated.