VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Green Acres
481 Bradley Street SW
Abingdon, VA 24210
(276) 258-5721

Current Inspector: Rebecca Berry (276) 608-3514

Inspection Date: Jan. 24, 2024 and 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 22VAC40-90 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: 01/24/2024, 10:10am to 2:07pm, 01/25/2024, 10:00am to 12:50pm 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: 68 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 9 Number of staff records reviewed: 7 Number of interviews conducted with residents: 4 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 Becky Berry, Licensing Inspector at 276-608-3514 or by email at rebecca.berry@dss.virginia.gov.

Violations:

Standard #:	22VAC40-73-750-E
Description:	Based on observations made during the tour of the building, the facility failed to have sufficient bed and bath linens in good repair so that residents always have clean sheets. EVIDENCE: 1. There were no sheets observed on either bed in resident room #11. 2. There were no sheets observed on the bed closest to the door in resident room #17.
Plan of Correction:	1-2. Staff will ensure that upon start of shift rounds to make beds will be conducted. [SIC]
Standard #:	22VAC40-73-870-A
Description:	Based on observations made during the tour of the building, the facility failed to ensure the interior and exterior of all buildings shall be maintained in good repair and kept clean and free of rubbish. EVIDENCE: 1. There was a dark substance on the floor around the base of the toilet in restroom #1. 2. The trash can in restroom #2 was full and overflowing. 3. The trash can in resident room #8 was full and two empty soda bottles and an empty take out drink cup was observed on the bed side table next to the bed closest to the door. 4. There were several dark spots observed on the wall and just above the baseboard on both sides and behind the toilet in restroom #3; the paint was also peeling in the corner by the toilet, approximately 15 inches from the floor. The baseboards behind and to the right of the base of the sink appeared dirty with dark spots/areas in the same restroom. 5. In resident room #11, there were food crumbs and other dirt and debris under the bed closest to the door, including an empty foam cup and two small pieces of paper. 6. Several pieces of toilet paper were observed in the floor of restroom #14, around the toilet. 7. The trash can in restroom #16 was full and overflowing.
Plan of Correction:	1-7. Nightshift will make rounds that bathrooms are left tidy at end of shift prior to arrival of dayshift. Maintenance to correct any peeling paint, fixtures, etc. Dayshift staff will split up to ensure resident rooms are cleaned within timely manner. [SIC]
Standard #:	22VAC40-73-870-E
Description:	Based on observations made during the tour of the building, the facility failed to ensure all furnishings, fixtures, and equipment, including furniture, window coverings, sinks, toilets, bathtubs, and showers, shall be kept clean and in good repair and condition. EVIDENCE: 1. The caulking of the shower in restroom #1 was cracked all along the top where the shower meets the wall. 2. The toilet seat in restroom #1 had a brown stain all along the inside ring of the seat.
Plan of Correction:	1. Maintenance will address and correct caulking. 2. Any commode/toilet seat will be replaced. Maintenance will replace. [SIC]
Standard #:	22VAC40-73-920-C
Description:	Based on observations made during the tour of the building, the facility failed to ensure ventilation to the outside in order to eliminate foul odors in all bathrooms. EVIDENCE: 1. The exhaust fan in restroom #4 did not appear to be in working order as it made no sound when switched on. 2. The exhaust fan in restroom #9 did not appear to be in working order as it made no sound when switched on.
Plan of Correction:	1. Maintenance will address and correct/repair/replace. 2. Maintenance will address and correct/repair/replace. [SIC]
Standard #:	22VAC40-73-940-A
Description:	Based on a review of facility records and interviews with staff, the facility failed to comply with the Virginia Statewide Fire Prevention Code (13VAC5-51) as determined by at least an annual inspection by the appropriate fire official. EVIDENCE: 1. The available Fire Code Inspection Report indicates the most recent annual inspection occurred on 11/30/2022. 2. Per staff #6 and #7 a more recent report was not available at the facility.
Plan of Correction:	1. Contacted Fire Marshal. Stated he was under impression facility had been moved to town jurisdiction from state, and town assumed still under state jurisdiction. However, fire inspection scheduled 1/26/24. No violations cited. Facility administration will f/u to ensure oversight of inspection is no longer overlooked. [SIC]
Standard #:	22VAC40-80-120-E-1
Description:	Based on observations made during the tour of the building, the facility failed to ensure certain documents related to the terms of the license are posted as required on the premises of the facility, including the most recently issued license. EVIDENCE: 1. The posted license was effective February 26, 2022 through February 25, 2023. 2. The current license is effective February 26, 2023 through February 25, 2024 and was not posted in the facility on the date of inspection.
Plan of Correction:	1-2. Original license(s) all are kept in main office. Office manager has been instructed newest license are to be posted on top. [SIC]