VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Cambridge Landing Assisted Living & Memory Care
304 Bowman Mill Road
Strasburg, VA 22657
(540) 465-5900

Current Inspector: Jill James (540) 418-2631

Inspection Date: Nov. 6, 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

Technical Assistance:

Please submit your renewal application 30 days prior to the expiration of your current license. A new license cannot be issued without the submission of a renewal application.

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: LI entered the facility at 8:30 am on 11/6/2023 and exited at 2:00 pm. 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: 24 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 residents: 0 Number of interviews conducted with staff: 0 Observations by licensing inspector: LI observed medication administration. LI observed residents eating breakfast and lunch. Additional Comments/Discussion: 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 Jamie Eddy, Licensing Inspector at (703) 479-5247 or by email at jamie.eddy1@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-680-D
Description:	Based on a review of records during the renewal inspection on 11/6/2023, the facility failed to ensure that medications were administered in accordance with the physician?s or other prescriber?s instructions for one of six residents. Evidence: 1. The November 2023 Medication Administration Record (MAR) for Resident 5 (R5) documented that at approximately 8:00 am on 11/6/2023 the systolic blood pressure for R5 was 109. 2. The signed physician?s orders of 4/10/2023 documented that R5 is not to receive Metoprolol 25 mg if systolic blood pressure is less than 110. 3. According to the November 2023 MARS, Staff #1 administered Metoprolol at approximately 8 am on 11/6/2023 to R5.
Plan of Correction:	The provider?s responses for the ?plan of correction? were not received as of 12/5/2023 and will not appear on the violation notice.
Standard #:	22VAC40-73-680-I
Description:	Based upon a review of records, the facility failed to ensure that Medication Administration Records (MARS) included date and time given and initials of direct care staff administering the medication for one of six residents. Evidence: 1. According to the Controlled Drug Record for Resident 1 (R1), staff administered an as needed (prn) dose of Lorazepam on 11/2/2023 at approximately 6:15 pm. 2. There are neither initials of staff administering the prn Lorazepam, nor the time given documented on the MARS for R1 on 11/2/2023.
Plan of Correction:	The provider?s responses for the ?plan of correction? were not received as of 12/5/2023 and will not appear on the violation notice.