VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Spring Arbor of Williamsburg
935 Capitol Landing Drive
Williamsburg, VA 23185
(757) 565-3583

Current Inspector: Alyshia E Walker (757) 670-0504

Inspection Date: Oct. 18, 2022 , Oct. 25, 2022 and Nov. 1, 2022

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 BACKGROUND CHECKS FOR ASSISTED LIVING FACILITIES 22VAC40-90 THE SWORN STATEMENT OR AFFIRMATION 22VAC40-90 THE CRIMINAL HISTORY RECORD REPORT 22VAC40-80 THE LICENSE

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: 10/18/2022, 10/25/2022, 11/01/2022 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: 76 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 8 Number of staff records reviewed: 5 Number of interviews conducted with residents: 3 Number of interviews conducted with staff: 3 Observations by licensing inspector: Licensing inspector observed activities, meals, conducted water temperature checks in resident rooms. Additional Comments/Discussion: n/a 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 Alyshia E. Walker, Licensing Inspector at (757) 670-0504 or by email at Alyshia.Walker@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-250-D
Description:	Based on a review of staff records the facility failed to ensure that each staff person submit the results of a tuberculosis (TB) risk assessment on or within seven days prior to the first day of work at the facility and that each staff person submit the results of a risk assessment annually. Evidence: The staff record for Staff #2 (D.O.H. 7-12-2022) contained a TB screening was dated 4-12-2021.
Plan of Correction:	It is Spring Arbor of Williamsburg?s policy to comply with all state regulations regarding Staff Records and Health Requirements. The community?s Business Office Manager will conduct an audit of each staff member?s subsequent paperwork to ensure all TB screenings are compliant with the regulation. The community?s Business Office Manager will ensure each team member completes and submits the results of their TB Screening on or within seven days prior to the first day of work.
Standard #:	22VAC40-73-310-H
Description:	Based on record review and staff interview, the facility failed to ensure it did not admit or retain individuals with psychotropic medications without a treatment plan. Evidence: Resident # 2`s October 2022 MAR documented the resident was prescribed Seroquel (10-1-2022), the psychotropic treatment plan was not signed until 10-25-2022.
Plan of Correction:	It is Spring Arbor of Williamsburg?s policy to comply with all state regulations regarding Admission and Retention of Residents. The community?s Resident Care Director will ensure each resident has a signed psychotropic treatment plan upon admission, and a psychotropic treatment plan in place for any resident who is prescribed a psychotropic medication post-admission.
Standard #:	22VAC40-73-450-C
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure the individualized service plan (ISP) included all assessed needs. Evidence: Resident # 4?s record documented the resident was receiving wound care services. The ISP dated 6-21-22 was not updated to reflect that wound care services were being provided.
Plan of Correction:	It is Spring Arbor of Williamsburg?s policy to comply with all state regulations regarding Individualized Service Plans. The resident?s individualized service plan will identify services and related information for the wound care the resident is receiving. The community?s Resident Care Director will audit each ISP to identify home health needs, orders and services are being provided.
Standard #:	22VAC40-73-680-I
Description:	Based on documentation review, the facility failed to include all required documentation on the Medication Administration Record (MAR). Evidence: 1.The October2022 MAR for Resident #5 did include a diagnosis, condition, or specific indications for administering the following medications: Albuterol U/D 0.083% Solution, Escitalopram 10 mg, Ferrous Sulfate 325mg, and Lactinex gran 12x1gm packet. 2. The October2022 MAR for Resident #2 did include a diagnosis, condition, or specific indications for administering the following medications: Advair Diskus, Aspercrm/Lido 4%, Diclofenac Sodium 1%, Docusate 100mg, and Gabapentin 100mg.
Plan of Correction:	It is Spring Arbor of Williamsburg?s policy to comply with all state regulations regarding Administration of Medications and Related Provisions. Resident #2?s MAR has been updated to include diagnosis for all listed medication without diagnosis. The community?s Resident Care Director will audit all resident MARs to identify and resolve any missing diagnoses.