VIRGINIA DEPARTMENT OF SOCIAL SERVICES

The Warren
935 S Ox Road
Woodstock, VA 22664
(540) 459-2525

Current Inspector: Jeffrey Marnien (540) 571-0189

Inspection Date: Feb. 1, 2024

Complaint Related: Yes

Areas Reviewed:

Personnel

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: 2/1/2024, 9:30am-1:30pm The acknowledgement of inspection for was signed and left at the facility for each date of the inspection. A complaint was received by VDSS Division of Licensing on 1/16/2024 regarding allegations in the area of personnel. Number of residents present at the facility at the beginning of the inspection: 33 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of staff records reviewed: 2 Number of interviews conducted with residents: 0 Number of interviews conducted with staff: 1 An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation supported the allegations of non-compliance with standards or law, and violations were issued. Any violation(s) not related to the complaint but identified during the course of the investigation can also be founds 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 the applicable standards 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 VDSS Licensing Programs, please visit: www.dss.virginia.gov Should you have any questions, please contact Sarah Pearson, Licensing Inspector at (540) 680-9469 or by email at sarah.pearson@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-250-C
Complaint related:	No
Description:	Based on a review of records conducted during complaint inspection on 2/1/2024, the facility failed to maintain in the staff record a sworn disclosure statement for one of two staff records. Evidence: No sworn disclosure statement was found in the record for Staff 1 who was hired on 11/20/2023.
Plan of Correction:	Resident Care Director with the support of the Executive Director will conduct an audit of all current staff charts for disclosure statement completion and ensure that all new staff hired, moving forward will complete the sworn disclosure statement as part of the new hire paperwork. Executive Director will provide ongoing oversight to ensure compliance.
Standard #:	22VAC40-73-260-A
Complaint related:	No
Description:	Based on a review of records, the facility failed to ensure that each direct care staff member without current certification in first aid received certification in first aid within 60 days of employment for one of two staff records. Evidence: Staff 1 was hired as direct care aide on 11/20/23. The staff record for Staff 1 did not contain first aid certification.
Plan of Correction:	Resident Wellness Director with the support of the Resident Care Director will ensure that all team members are enrolled and receive First Aide Certification within their first 60 days of employment. Executive Director will provide oversight to ensure compliance.