VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Watercrest Richmond Assisted Living and Memory Care
5250 Grandin Avenue
Moseley, VA 23120
(804) 395-7107

Current Inspector: Tamara Watkins (804) 662-7422

Inspection Date: May 11, 2023

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 ARTICLE 1 ? SUBJECTIVITY 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 22VAC40-80 THE LICENSING PROCESS 22VAC40-80 COMPLAINT INVESTIGATION 22VAC40-80 SANCTIONS

Comments:

Type of inspection: Monitoring Date(s) of inspection 5/11/2023 1:20p ? 4:30p the licensing inspector was on-site at the facility for each day of the inspection. 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: 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: 6 Number of staff records reviewed: 3 Number of interviews conducted with staff: 2 Additional Comments/Discussion: 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 Tamara Watkins, Licensing Inspector at (804) 662-7422 or by email at tamara.g.watkins@dss.virginia.gov Violation Notice Issued: Yes

Violations:

Standard #:	22VAC40-73-320-A
Description:	Based on a review of resident records the facility failed to ensure that resident physical examinations were within 30 days preceding admission. Evidence: The date of admission for resident #1 is 4/19/2023. The admission physical examination is dated 11/23/2022. The date of admission for resident #6 is 4/17/2023. The admission physical examination is dated 2/13/2023.
Plan of Correction:	Plan of Correction - Facility will ensure that the resident physical examination is within 30 days preceding admission. This will be the responsibility of the Resident Wellness Director. Date corrected 5/12/2023
Standard #:	22VAC40-73-450-A
Description:	Based on a review of resident records the facility failed to document if resident individualized service plans were developed on or within seven days prior to the day of admission. Evidence: The individualized service plan for resident?s #1,2,3,4,5,6 were developed electronically. All the plans reviewed were dated 5/11/2023 the date of this inspection. The original date the plan was created was overwritten with the current date.
Plan of Correction:	Plan of Correction - Facility will ensure that Individualized Service Plans are developed on or within seven days prior to admission. We are working on our electronic ISP's to reflect the correct dates. This will be the responsibility of the Resident Wellness Director. Date to be Corrected 6/12/2023
Standard #:	22VAC40-73-450-C
Description:	Based on a review of resident records the individualized service plans failed to include all the elements of the comprehensive individualized service plan. Evidence: The service plans reviewed for residents #1,2,3,4,5,6 did not contain a description of identified needs and date identified, fall risk rating, a written description of what services will be provided to address the identified needs, when and where the services will be provided, expected outcome and time frame, a statement that specifies whether the resident does or does not need to have a staff and awake on duty at night.
Plan of Correction:	Plan of Correction - Facility will ensure that all elements of the Comprehensive ISP will be addressed. This includes, fall risk rating, a written description of what services will be provided to address the identified needs, when and where and expected outcome and time frame. This will be the responsibility of the Resident Wellness Director. We are working on our electronic ISP to reflect the above. Date to be corrected 6/12/2023
Standard #:	22VAC40-73-720-A
Description:	Based on a review of resident records the facility did not include Do Not Resuscitate Orders in individualized service plans. Evidence: Resident?s #2&4 have valid DNR orders in their record, but the orders are not included in their individualized service plans.
Plan of Correction:	Plan of Correction - Facility will ensure that DNR's will be included on the Individualized Service Plan. This will be the responsibility of the Resident Wellness Director. Date of Correction 5/12/2023