VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Gray Ridge Village LLC
155 Ridgefield Rd
Marion, VA 24354
(276) 521-0784

Current Inspector: Rebecca Berry (276) 608-3514

Inspection Date: July 9, 2024 , July 24, 2024 and Aug. 8, 2024

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 PERSONNEL 22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-73 RESIDENT ACCOMMODATIONS AND RELATED PROVISIONS

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: 07/09/2024 11:31am to 12:50pm, 07/24/2024 1:13pm to 2:05pm, 08/08/2024 3:11pm to 3:26pm 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 07/08/2024 regarding allegations in the area(s) of: Resident care and related services and resident accommodations. Number of residents present at the facility at the beginning of the inspection: 75 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: 2 Number of interviews conducted with residents: 0 Number of interviews conducted with staff: 3 Observations by licensing inspector: Additional Comments/Discussion: 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 Becky Berry, Licensing Inspector at 276-608-3514 or by email at rebecca.berry@dss.virginia.gov.

Violations:

Standard #:	22VAC40-73-450-H
Complaint related:	Yes
Description:	Based on a review of resident records and interviews with staff, the facility failed to ensure that the care and services specified in the individualized service plan are provided to each resident. 1. The Uniform Assessment Instrument (UAI) for resident #1, completed on 05/03/2024, identifies bathing, mechanical and human help/supervision, as an area in which resident #1 requires assistance. 2. The Individualized Service Plan (ISP) for resident #1, completed 05/03/2024, states resident #1 will receive the following assistance with bathing: Supervision, for bathing and shampooing of hair due to unsteady gait at times, by direct care staff, twice weekly and as needed in shower room, to maintain optimal personal hygiene. 3. Per staff #1, resident #1 is not included on the list of residents requiring assistance with bathing. Staff #1 reports assistance is provided if/when resident #1 asks for help, but otherwise resident #1 is independent in bathing. Staff #1 also confirmed resident #1 does have unsteady gait at times.
Plan of Correction:	All UAIs will be reviewed with Direct Care staff to ensure compliance. [SIC]
Standard #:	22VAC40-73-470-A
Complaint related:	No
Description:	Based on a review of resident records and interview with staff, the facility failed to ensure, either directly or indirectly, that the health care service needs of residents are met by any of the following ways: Staff of the facility providing health care services; persons employed by a resident providing health care services; or the facility assisting residents in making appropriate arrangements for health care services. 1. Per the physician?s order dated 05/07/2024, resident #1 uses a Freestyle Libre 2 Sensor with the following instructions: Change every 14 days for DM (diabetes mellitus). 2. Per 22VAC40-73-10, "Direct care staff" means supervisors, assistants, aides, or other staff of a facility who assist residents in the performance of personal care or daily living activities. 3. Per 22VAC40-73-10, "Health care provider" means a person, corporation, facility, or institution licensed by this Commonwealth to provide health care or professional services, including a physician or hospital, dentist, pharmacist, registered or licensed practical nurse, optometrist, podiatrist, chiropractor, physical therapist, physical therapy assistant, clinical psychologist, or health maintenance organization. 4. Per staff #1, staff #2 and staff #3 apply the Freestyle Libre 2 Sensor for resident #1 as noted above in item #1. 5. Staff #2 is registered with the Virginia Board of Nursing as a medication aide (RMA), and both staff #2 and staff #3 have completed the requirements set forth by the National Healthcare Association as a Certified Clinical Medical Assistant (CCMA). 6. Staff #2 and staff #3 are considered direct care staff and are not licensed by the Commonwealth to provide health care services.
Plan of Correction:	Only staff with license (RN or LPN) will change all Freestyle Libre 2 sensors or any other sensors used for the monitoring of DM. [SIC]
Standard #:	22VAC40-73-670-1
Complaint related:	No
Description:	Based on a review of resident records and interviews with staff, the facility failed to ensure that when staff administers medications to residents, all staff responsible for medication administration shall be licensed by the Commonwealth of Virginia to administer medications, or be registered with the Virginia Board of Nursing as a medication aide. EVIDENCE: 1. The date of hire for staff #3 was 07/20/2023. 2. Per interview with staff #1, staff #3 was hired to administer medications to residents. 3. Per interview with staff #3, her primary responsibility as an employee at the facility is to administer medications to residents. 4. Per interview with staff #3, she has completed the requirements set forth by the National Healthcare Association as a Certified Clinical Medical Assistant (CCMA), but she is not registered with the Virginia Board of Nursing as a medication aide (RMA), nor is she licensed by the Commonwealth of Virginia to administer medications.
Plan of Correction:	All staff who administer medications will be compliant, with being registered with the Virginia Board of Nursing. [SIC]