VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Spring Arbor Cottage of Salisbury
14020 Steeplestone Drive
Midlothian, VA 23113
(804) 897-3332

Current Inspector: Shelby Haskins (804) 305-4876

Inspection Date: Feb. 29, 2024

Complaint Related: No

Areas Reviewed:

22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES 22VAC40-73 PERSONNEL 22VAC40-73 STAFFING AND SUPERVISION 22VAC40-73 RESIDENT CARE AND RELATED SERVICES

Technical Assistance:

N/A

Comments:

Type of inspection: Monitoring Date of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 02/29/2024 10:25am The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. A self-reported incident was received by VDSS Division of Licensing on 02/13/2024 regarding allegations in the area(s) of: Number of residents present at the facility at the beginning of the inspection: 46 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 2 Number of staff records reviewed: 1 Number of interviews conducted with residents: 0 Number of interviews conducted with staff: 2 Observations by licensing inspector: Pictures of two residents involved did not appear them to be injured, bruising, etc. Additional Comments/Discussion: The executive director and staff were very knowledgeable of the incident and acted quickly in their own investigation and terminating the staff accused of the incident. An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation supported the self-report of non-compliance with standard(s) or law, and violation(s) were issued. Any violation(s) not related to the self-report 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. 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. For more information about the VDSS Licensing Programs, please visit: www.dss.virginia.gov Should you have any questions, please contact Shelby Haskins, Licensing Inspector at (804) 305-4876 or by email at Shelby.Haskins@dss.virginia.gov.

Violations:

Standard #:	22VAC40-73-110-1
Description:	Based on a review of documentation and interviews, it was determined that the facility did not ensure all staff shall be considerate and respectful of the rights, dignity, and sensitivities of persons who are aged, infirm, or disabled. Evidence: 1. On 2/7/24 staff #1 popped resident #1 in the mouth 2. On 2/7/24 staf#1 pinched and twisted the lips of resident #2 3. In a written statement staff #2 stated that she witnessed staff#1 pop resident #1 in the mouth and then pinch and twist the lips of resident #2 on 2/7/24. 4. Staff #3 confirmed that staff #1 had popped resident #1 in the mouth, and then pinched and twisted the lips of resident #2 on 2/7/24.
Plan of Correction:	Upon receiving report of team member?s disregard for residents? rights and dignity, the team member was suspended immediately, and an investigation was initiated. Both residents were assessed by the Director of Quality and Education as well as their Nurse Practitioner and no injuries were noted. Adult Protective Services, Department of Social Services and the POA?s were notified of allegations and investigation. The investigation concluded with the team member being terminated.