VIRGINIA DEPARTMENT OF SOCIAL SERVICES

The Blake at Charlottesville
250 Nichols Court
Charlottesville, VA 22901
(434) 973-7900

Current Inspector: Kimberly Davis (804) 662-7578

Inspection Date: March 20, 2024

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 RESIDENT CARE AND RELATED SERVICES

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: 3-20-24 from 12:30 p.m.-2:20 p.m. 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 1-19-24 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: 115 Number of resident records reviewed: 1 Number of interviews conducted with staff: 1 An exit meeting was conducted to review the inspection findings. The evidence gathered during the investigation supported some, but not all of the allegation(s); area(s) of non-compliance with standard(s) or law were: resident care. A violation notice was issued; any violation(s) not related to the complaint 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 Kimberly Davis, Licensing Inspector at (804) 662-7578 or by email at Kimberly.M.Davis@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-440-A
Complaint related:	No
Description:	Based on a review of resident records the facility failed to ensure that all residents of and applicants to assisted living facilities shall be assessed face to face using the uniform assessment instrument in accordance with Assessment in Assisted Living Facilities. The UAI shall be completed prior to admission, at least annually, and whenever there is a significant change in the resident's condition. Evidence: The record for Resident # 1 did not contain a UAI and Staff # 1 was unable to locate the resident?s UAI.
Plan of Correction:	The Facility will reeducate staff to ensure that Uniform Assessment Instruments (UAI) are completed prior to admission, annually, and whenever there is a significant change in the resident?s condition. UAIswill be updated as they mature. The Facility is in the process of auditing UAIs and will create a tracker to properly identify necessary UAI updates/revisions. The tracker will review the UAIs monthly. The Director of Wellness (and/or an appropriate designee) will retrieve data from the tracker and complete the UAIs as needed per the above. The Executive Director will spot check the Director of Wellness?s above-described efforts monthly for three consecutive months.
Standard #:	22VAC40-73-450-E
Complaint related:	No
Description:	Based on a review of resident records the facility failed to ensure the individualized service plan (ISP) shall be signed and dated by the licensee, administrator, or his designee, (i.e., the person who has developed the plan), and by the resident or his legal representative. Evidence: The record for Resident # 1 contained an ISP that was not signed or dated at all.
Plan of Correction:	The Facility will complete each Individualized Service Plan (ISP) as required and on time. Each ISP will be signed and dated by the Facility?s Executive Director or Director of Wellness or an appropriate designee and by the resident or their legal representative. NOTE: The Facility is in the process of identifying residents in need of an updated ISP. The Director of Wellness (and/or an appropriate designee) will be responsible for reviewing and completing all such ISPs. The Executive Director will spot check five ISPs each month for compliance for three consecutive months.
Standard #:	22VAC40-73-460-H
Complaint related:	Yes
Description:	Based on a review of resident records the facility failed to ensure that personal assistance and care are provided to each resident as necessary so that the needs of the resident are met, including assistance or care with: bathing - at least twice a week, but more often if needed or desired; trimming fingernails and toenails (certain medical conditions necessitate that this be done by a licensed health care professional). Evidence: - The facility?s Task Administration Record for Resident # 1 for Bathing Assistance for the month of December 2023 only contained documentation of staff initials on 12-21-23 and 12-28-23. -The facility?s Task Administration Record for Resident # 1 for the month of December 2023 contained no documentation of staff initials at all for Nail Care Assistance. - The facility?s Task Administration Record for Resident # 1 for the month of December 2023 contained no documentation of staff initials at all from December 1-13, 2023 for 19 of 20 daily tasks identified, except CPAP or BIPAP machine assistance.
Plan of Correction:	The Facility shall ensure that personal assistance and care are provided to each resident as necessary, so the needs of the resident are met, all per the ISPs. All direct care staff are being reeducated on daily charting of each resident?s ADL?s tasks. The Director of Wellness (and / or an appropriate designee) will monitor daily charting and follow up as necessary. The Executive Director will spot check the above-described efforts and tasks daily for three consecutive months.