VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Harmony at Harbour View
5871 Harbour View Boulevard
Suffolk, VA 23435
(757) 214-6279

Current Inspector: Donesia Peoples (757) 353-0430

Inspection Date: Oct. 29, 2024 and Nov. 15, 2024

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 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS 22VAC40-90 THE SWORN STATEMENT OR AFFIRMATION 22VAC40-90 THE CRIMINAL HISTORY RECORD REPORT 22VAC40-80 THE LICENSE 22VAC40-80 THE LICENSING PROCESS

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: An unannounced monitoring inspection took place on 10/29/24 at 9:33 am to 3:50 pm and 11/15/24 at 8:30 am to 12:40 pm. The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. A self-report was received by VDSS Division of Licensing on 10/24/2024 regarding allegations in the area of: Resident Care and Related Services Number of residents present at the facility at the beginning of the inspection: 84 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 1 Number of staff records reviewed: 1 Number of interviews conducted with residents: 0 Number of interviews conducted with staff: 3 Observations by licensing inspector: An observation of the facility?s community bus was completed. Additional Comments/Discussion: None An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation supported the self-report of non-compliance with standard(s) or law, and violation(s) were issued. Any violation(s) not related to the self-report but identified during the course of the investigation can also 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 Donesia Peoples, Licensing Inspector at 757-353-0430 or by email at donesia.peoples@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-40-A
Description:	Based on the record review and staff interview it was determined that the facility failed to ensure the licensee shall ensure compliance with all regulations for licensed assisted living facilities and terms of the licensee issued by the department; with relevant federal, state, and local laws; with other relevant regulations; and with the facilities own policies and procedures. Evidence: 1. The facility?s Vehicle Safety Program Policy includes the following statements: a) ?Motor vehicle reports should be obtained before hiring and, on all drivers, annually.? b) ?Drivers are required to sign the vehicle safety program acknowledgement form.? c) ?all Drivers are required to complete initial safe driving training.? d) ?the Driver and all occupants are required to wear safety belts when operating or driving in a motor vehicle. The Driver is responsible to ensure all passengers are wearing their safety belts.? 2. The record for staff #1, hire date 08/05/22 does not contain the following as required per the facility?s vehicle safety Program Policy: a) A motor vehicle report completed at hire, and/or an annual motor vehicle report completed prior to the incident on 10/13/24. b) The facility?s vehicle safety program acknowledgement form. c) Documentation of completion of the facility?s ?initial safe driver training.? 3. Staff #1 confirmed resident #1 was not strapped into a seatbelt while being transported on the facility?s community bus as she did not physically assist resident #1 with using and securing the seatbelt.
Plan of Correction:	The Executive Director will ensure compliance with all regulations for licensed assisted living facilities and with the facility's own policies and procedures. Executive Director or designee will re-educate all drivers for the community on the policy and procedure (Vehicle Safety Program). Motor Vehicle Reports will be accessed immediately for all transport drivers hired at the community. Reports will be accessed and reviewed upon hire and annually thereafter.
Standard #:	22VAC40-73-460-A
Description:	Based on the record review and staff interview it was determined that the facility failed to ensure the facility shall assume general responsibility for the health, safety, and well-being of the residents. Evidence: 1. According to the facility?s incident report on 10/23/24 staff #1 was operating the facility?s bus and ?while returning from a lunch outing, resident #1 was thrown from her wheelchair while in transit on the community bus. ? ?Resident #1 suffered a laceration to the top upper left portion of her head. Resident #1 was transported to Norfolk General by EMS. Resident #1 is stable with two fractures of her neck.? 2. During an interview, staff #1, stated that she ?stopped on the brakes? to prevent hitting another car who immediately stopped in front of the community bus, and that resident #1 was ?thrown from her wheelchair? and ?slid? to the front of the bus.? Resident #1 suffered an ?injury to her head and was bleeding.? 3. Staff #1 confirmed resident #1 was not strapped into a seatbelt while being transported on the transport bus prior to the incident and staff #1 did not ensure resident #1 was secured in a seatbelt prior to being transported on the community bus.
Plan of Correction:	The Executive Director will ensure compliance with all regulations for licensed assisted living facilities and with the facility's own policies and procedures. Executive Director or designee will re-educate all drivers for the community on the policy and procedure (Vehicle Safety Program). The re-education shall include demonstration of how to properly secure seat belts during resident transport.