VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Valley ALF Operator LLC
940 East Lee Hwy
Chilhowie, VA 24319

Current Inspector: Crystal Mullins (276) 608-1067

Inspection Date: Dec. 14, 2021

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 ACCOMODATIONS AND RELATED PROVISIONS 22VAC40-73 BUILDING AND GROUNDS 22VAC40-73 EMERGENCY PREPAREDNESS

Comments:

Two licensing inspectors conducted a one day renewal inspection at Valley ALF Operator LLC on 12/14/2021. The inspection started at 9:15 am and concluded at 12:44pm. A sample of five resident files and three staff files were reviewed and the noon medication pass was observed. Medication Administration Records, medications, and physician's orders were reviewed. A tour of the building and grounds was completed and lunch was observed. Residents were interviewed. The first aid kit and blood glucose monitoring supplies were observed and reviewed. Areas of non-compliance are identified on the attached violation notice. An exit meeting was conducted with the administrator on 12/14/2021 and the findings were reviewed. Opportunity was given to find items that were not available in the records. Please complete the columns for "description of action to be taken" and "date to be corrected" for each violation cited on the violation notice, then return a signed and dated copy to the licensing office within 10 calendar days (12/31/2021) of receipt. If you have any questions or concerns please feel free to contact your inspector at 276-608-1067. Thank you for your cooperation and assistance.

Violations:

Standard #:	22VAC40-73-50-A
Description:	Based on observations made during review of resident records, the facility failed to prepare and provide a disclosure statement to each resident and his legal representative. EVIDENCE: 1. Three out of five resident files did not contain a disclosure statement dated when the new management company assumed responsibility in August 2020.
Plan of Correction:	A new disclosure statement will be obtained for all residents prior to the new management take over on 01/01/2020. [sic]
Standard #:	22VAC40-73-310-D
Description:	Based on observations made during the review of resident records, the facility failed to provide written assurance to the resident or legal representative that the facility has the appropriate license to meet his care needs at the time of admission, this document shall be signed and kept in the resident's record. EVIDENCE: 1. Three out of five resident files did not contain written assurance documented in the resident files when the new management company assumed responsibility in August 2020.
Plan of Correction:	A new updated document including the new management company explanation including the facility has the appropriate license to meet the care needs will be sent to residents and legal representatives. [sic]
Standard #:	22VAC40-73-350-B
Description:	Based on observations made during review of resident records, the facility failed to ascertain, prior to admission, whether a potential resident is a registered sex offender. EVIDENCE: 1. Three out of five resident files did not contain dated documentation of the sex offender check dated when the new management company assumed responsibility in August 2020.
Plan of Correction:	A new sex offender check will be completed on residents admitted prior to new management take over on 01/01/2020. [sic]
Standard #:	22VAC40-73-380-A
Description:	Based on observations made during review of resident records, the facility failed to maintain and updated prior to admission personal and social data. EVIDENCE: 1. Three out of five resident files did not contain updated documentation of resident personal and social data dated when the new management company assumed responsibility in August 2020.
Plan of Correction:	New social data will be obtained on all residents prior to new management take over on 01/01/2020. [sic]
Standard #:	22VAC40-73-390-A
Description:	Based on observations made during review of resident records, the facility failed to have an up to date admission agreement with residents. EVIDENCE: 1. Three out of five resident files did not contain updated documentation of the resident agreement with the facility dated when the new management company assumed responsibility in August 2020.
Plan of Correction:	A new admissions agreement will be obtained on all new residents prior to new management take over on 01/01/2020. [sic]
Standard #:	22VAC40-73-410-A
Description:	Based on observations made during review of resident records, the facility failed to document resident orientation to the facility. EVIDENCE: 1. Three out of five resident files did not contain dated documentation of the new resident orientation dated when the new management company assumed responsibility in August 2020.
Plan of Correction:	A new orientation will be conducted and documented for all residents prior to new management take over on 01/01/2020. [sic]