VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Pinecrest Assisted Living Facility, LLC
709 River Ridge Road
Danville, VA 24541

Current Inspector: Angela Marie Swink (276) 623-6575

Inspection Date: July 17, 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 32.1 REPORTED BY PERSONS OTHER THAN PHYSICIANS 63.2 GENERAL PROVISIONS 63.2 PROTECTION OF ADULTS AND REPORTING 63.2 LICENSURE AND REGISTRATION PROCEDURES 63.2 FACILITIES AND PROGRAMS 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: Renewal Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 7/17/2024 08:25 to 13:45 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: 38 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: 2 Number of interviews conducted with staff: 5 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 A Marie Swink, Licensing Inspector at 276-623-6575 or by email at angela.swink@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-190-C
Description:	Based on staff record review and staff interview, the facility failed to ensure that prior to being placed in charge, the staff member was informed of and received training on their duties and responsibilities and provided written documentation of such duties and responsibilities. EVIDENCE: 1. Staff 6 record did not contain written documentation of duties and responsibilities prior to being placed in charge. 4. On the day of inspection during an interview with the licensing inspector and staff 2, staff 2 confirmed staff 6 has been the staff in charge at times at the facility. Staff 2 confirmed staff 6 record to be current.
Plan of Correction:	Staff 2 developed a policy on 7.18.24, Designated Staff Persons in Charge. This policy was provided to and signed by Staff 6 on 7.18.24. The Administrator also shared this policy with all employees, so they are aware of the Designated Staff Persons in Charge Policy & Procedure. Moving forward, this policy will be provided in Orientation and discussed periodically in All Staff Meetings.
Standard #:	22VAC40-73-270-1
Description:	Based on resident record review, staff record review and staff interview, the facility failed for direct care staff to be trained in methods of dealing with residents who have a history of aggressive behavior prior to being involved in the care of such residents. EVIDENCE: 1. Resident 5 record contained documentation from Resident Notes of the resident being aggressive as documented by the resident attempting to push and hit staff, and spitting on staff on 5/28/2024. 2.Staff 3 record, date of hire 2/5/2024, did not contain documentation of training in methods of dealing with residents who have a history of aggressive behavior. 4. On the day of inspection, during an interview with the licensing inspector and staff 2, staff 2 confirmed staff 3 record was current. Staff 2 confirmed that staff 3 did provide care for resident 5.
Plan of Correction:	Staff 2 informed Staff 3 on 7.17.24 that he needed to complete the Aggressive Behavior Training. Staff 2 advised Staff 3 on 7.17.24 not to work with Resident 5 until the training is completed. Staff 2 scheduled the training with Staff 3 for 8.7.24. Moving forward, the Aggressive Behavior Training will be provided in Orientation.
Standard #:	22VAC40-73-320-A
Description:	Based on resident record review and staff interview, the facility failed to ensure that a physical examination with all required information was obtained within 30 days preceding admission for a resident. EVIDENCE: 1. Resident 3 record, admitted to the facility on 6/20/2024, has documentation of a physical examination dated for 6/13/2024. The physical examination does not have documentation of the required information that includes a statement that the individual does not have any conditions or care needs prohibited by 22VAC40-73-310H and a statement that specifies whether the individual is or is not capable of self-administering medication. 2. On the day of inspection during an interview with the licensing inspector and staff 2, staff 2 confirmed resident 3 record to be current.
Plan of Correction:	Staff 2 notified Resident 3?s PCP, via email on 7.18.24 that his current H&P lacked the VDSS standards regarding prohibitive conditions and capacity (or not) to self-administer medications. Staff 2 requested the provider complete a new H&P for Resident 3 using the VDSS Physical Examination Form. Provider completed the VDSS Physical Examination Form and returned it to Staff 2 on 7.22.24. Moving forward, PineCrest Assisted Living will only accept the VDSS Physical Examination Form for prospects and residents.