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: Jan. 5, 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: 1/5/2024 10:55 am- 12:21 pm 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 12/6/2023 regarding allegations in the area(s) of: Resident Care and Related Services Number of residents present at the facility at the beginning of the inspection: 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: 0 Number of interviews conducted with residents: 1 Number of interviews conducted with staff: 3 Observations by licensing inspector: Licensing Inspectors observed residents eating lunch and activities being conducted. Additional Comments/Discussion: An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation supported the allegation(s)of non-compliance with standard(s) or law, and violation(s) were issued. Any violation(s) not related to the complaint(s) but identified during the course of the investigation can also 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 Alyshia Walker, Licensing Inspector at 757-670-0504 or by email at Alyshia.Walker@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-110-1
Complaint related:	No
Description:	Based on records reviewed, and staff interviewed the facility failed to ensure staff was considerate and respectful of the rights, dignity, and sensitives of person who are aged, infirmed, or disabled. Evidence: 1. The facility documented on Resident #1?s Resident Care Notes on 9/09/2023, the resident received a phone call from her son. When staff realized who the resident?s son was on the phone, staff terminated the call. The resident became upset when the call was terminated and called 911. 2. Staff # 3 acknowledged that she disconnected the call and Resident #1 became upset.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-810-B
Complaint related:	No
Description:	Based on interview, the facility failed to ensure that each resident shall reasonable access to nonpay phone. Evidence: 1. Staff #1 acknowledged that the facility has scheduled weekly phone calls between Resident #1 and the resident?s son which occur on Wednesdays. 2. Staff #1 acknowledged the weekly schedule was not devised by Resident #1?s guardian.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-810-C
Complaint related:	No
Description:	Based on record review and interviews, the facility failed to ensure privacy was provided for residents to use the telephone. Evidence: Staff members #1, #2, and #3 acknowledged that Resident #1?s phone calls to her son are monitored as the phone calls are placed on speaker phone and the staff members guide or interject topics during the phone calls when the conversations go into a direction that is upsetting to the resident.
Plan of Correction:	Not available online. Contact Inspector for more information.