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: Jan. 25, 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

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: 01/25/2025 Begin: 10:40am End: 3:15pm 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: 23 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: 3 Number of interviews conducted with residents: 3 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 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 Crystal B. Henson Licensing Inspector at 276-608-1067 or by email at crystal.b.mullins@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-250-C
Description:	Based on resident record review, the facility failed to ensure the personal and social data was entirely completed for one resident. EVIDENCE: 1. Resident #3 was admitted to the facility 04/11/2023. The personal social data sheet was observed to be blank in the following areas: clergyman and next of kin (x2) on page1. On page 2 the previous mental health or ID service history was checked to indicate YES, but the explanation box below was left blank.
Plan of Correction:	Social data sheet will be filled out completely upon admission. Staff/nursing staff will be educated on ensuring social data sheet has no holes and filled out completely. [sic]
Standard #:	22VAC40-73-680-D
Description:	Based on resident record review, the January MAR, and physician?s orders, the facility failed to administer medications in accordance with he physician?s or other prescriber?s instructions. EVIDENCE: 1. Resident #3 washas a physician?s order dated 01/02/2024 for Metoprolol Tartrate 100mg, one tablet by mouth twice daily; hold for systolic blood pressure less than 110 OR heart rate les than 60. According to the January 2024 Medication Administration Record (MAR), on 01/06/2024 the medication mentioned above as administered to the resident although his blood pressure was documented as 96/63.
Plan of Correction:	All medication nurses/med techs will follow physicians orders as ordered. Orders will be checked 3x during med pass, one while pulling meds, w for double checked, 3rd before giving BP meds BP will be obtained prior to BP meds being given. BP meds will be marked accordingly as if it was given or not. [sic]
Standard #:	22VAC40-73-870-A
Description:	Based on observations made during the tour of the building, the facility failed to maintain all interior and exterior of all buildings in good repair. EVIDCNECE: 1. A section of ceiling above the overhead light in the men?s shower room was observed to have a brown stained area (perhaps from a leak). 2. The women?s shower room was observed to have two rags placed above the heat/air system on the wall in order to cover existing holes in the sheet rock. When the LI removed these rags, LI was able to see the outside light shining through.
Plan of Correction:	Maintenance staff will be notified and ceiling above the overhead light in the men's shower room will be repaired and checked for leaks. Holes around heat/air system in women's shower room will be repaired by maintenance. Assisted living staff will be educated to report all needed repairs to maintenance staff. [sic]