VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Golden Care Group LLC
2800 Squire Court
Chesapeake, VA 23323
(470) 530-5184

Current Inspector: Donesia Peoples (757) 353-0430

Inspection Date: May 31, 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 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS 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

Comments:

Type of inspection: Monitoring Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: An unannounced monitoring inspection took place on 05/31/24 from 9:12 am to 11:42 am. 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: 2 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 3 Number of staff records reviewed: 1 Number of interviews conducted with residents: 1 Number of interviews conducted with staff: 2 Observations by licensing inspector: The medication storage area was reviewed. Additional Comments/Discussion: None 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 (Donesia Peoples), Licensing Inspector at (757)353-0430 or by email at donesia.peoples@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-120-A
Description:	Based on the onsite record review, it was determined that the facility failed to ensure the orientation and training required in subsection B and C of this section shall occur within the first seven working days of employment. Evidence: 1. There was no documentation for the orientation and training for staff #1 (date of hire 04/27/24), and staff #2 (date of hire, 04/27/24). 2.Staff #1, was unable to provide documentation during the onsite inspection that the orientation and training was completed for the staff #1, and staff #2.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-150-B
Description:	Based on the onsite staff interview the facility failed to ensure if an administrator dies, resigns, is discharged, or becomes unable to perform his duties. The facility shall immediately employ a new administrator or appoint a qualified acting administrator so that no lapse in administrator coverage occurs. Evidence: 1. During an interview with staff #1, staff #1 stated staff #4 is not currently a staff employee and is no longer the administrator providing administrator coverage for the facility. Staff #1 was not able to provide evidence of the facility employing a new administrator or a qualified acting administrator to provide administration coverage to the facility.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-250-D
Description:	Based on the onsite interview, it was determined that the facility failed to ensure health information required by these standards shall be maintained at the facility and shall be included in the staff record for each staff person. Evidence: 1. The initial risk assessment for tuberculosis (TB) for staff #1 (hire date 04/27/24), staff #2 (hire date 04/27/24), and staff #3 (hire date 05/31/24) were requested but were not available for viewing during the inspection. 2. Staff #1 was unable to provide documentation of a risk assessment for TB completed for staff #1, staff #2, and staff #3 during the onsite inspection.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-310-A
Description:	Based on the onsite record review the facility failed to ensure no resident shall be admitted or retained who requires a level of care or service or type of service for which the facility is not licensed or which the facility does not provide. Evidence: 1. The record for resident #1, admission date 03/11/24, contains a Uniform Assessment Instrument (UAI) dated 02/28/24 that includes the following statements: ?Yes, The individual meets nursing facility criteria;? ?Patient presents with a moderate severe disability and is unable to walk or attend to one?s own bodily needs without assistance. PT and OT recommends for patient to go to a SNF with the continuation of medical services.? The facility?s license is issued for residential living care only and does not include nursing facility level of care.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-310-B
Description:	Based on the onsite record review it was determined that the facility failed to ensure assisted living facilities shall not admit an individual before a determination has been made that the facility can meet the needs of the individual. Evidence: 1. The record for resident #1 did not contain a documented interview between the administrator or a designee responsible for admission and retention decisions, the individual and his legal representatives. 2. The record for resident #2, did not contain a completed UAI, and a documented interview between the administrator or a designee responsible for admission and retention decisions, the individual and his legal representatives. 3. The record for resident #3, did not contain a completed UAI, and a documented interview between the administrator or a designee responsible for admission and retention decisions, the individual and his legal representatives. 2. Staff #1 reviewed the records for resident #1, resident #2, and resident #3 and was unable to provide documentation during the onsite that an interview with the resident or his legal representative were completed prior to admission.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-310-D
Description:	Based on the onsite record review and interview, it was determined that the facility failed to provide written assurance to a resident or the legal representative documenting that the facility has the appropriate license to meet their care needs at the time of admission. Evidence: 1. The records for resident #1, resident #2, and resident #3 did not contain documentation of written assurance to the resident or the legal guardian documenting that the facility has the appropriate license to meet their care needs. 2. Staff #1 reviewed the records for resident #1, resident #2, and resident #3, and was unable to provide documentation during the onsite inspection that the records contained documentation of written assurance to the resident or the legal guardian documenting that the facility has the appropriate license to meet their care needs.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-430-H-1
Description:	Based on the record review the facility failed to ensure at the time of discharge, the assisted living facility shall provide to the resident, and as appropriate, his legal guardian and designated contact person a dated statement signed by the licensee or administrator that contains the items listed in this section. Evidence: 1. The record for resident #3, discharged 03/30/24, did not contain a discharge statement. 2. Staff #1 reviewed the record for resident #1 and was unable to provide a discharge statement completed for resident #1.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-440-A
Description:	Based on the onsite record review and interview, it was determined that the facility failed to ensure the Uniform Assessment Instrument (UAI) shall be completed prior to admission, at least annually, and whenever there is a significant change in the resident?s condition. Evidence: 1. The record for resident # 2, admission date 01/25/24, did not contain documentation of a Uniform Assessment Instrument (UAI). 2. The record for resident #3, admission date 03/05/24, did not contain documentation of a Uniform Assessment Instrument (UAI). 3. Staff #1 reviewed the records for resident #2, and resident #3, and was unable to provide documentation during the onsite inspection each resident had a completed Uniform Assessment Instrument (UAI).
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-450-C
Description:	Based on the onsite record review and interview, it was determined that the facility failed to ensure the Individualized Service Plan (ISP) shall be completed within 30 days after admission. Evidence: 1.The record for resident #1, admission date of 03/11/24, did not contain an ISP completed within 30 days after admission. 2. The record for resident #2, admission date of 01/25/24, did not contain an ISP completed within 30 days after admission. 3. Staff #1 reviewed the record for resident #1 and resident #2 and was unable to provide documentation during the onsite inspection that resident #1 and resident #2 had a completed Individualized Service Plan (ISP) within 30 days after admission.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-670-1
Description:	Based on the onsite record review, it was determined that the facility failed to ensure each staff person who administers medication shall be licensed by the Commonwealth of Virginia to administer medications or be registered with the Virginia Board of Nursing as a medication aide. Evidence: 1. During an interview with staff #1, staff #1 stated that staff #1 and staff #2 are the staff persons who administer medications to resident #1 and resident #2. Resident?s #1 April and May 2024 Medication administration record (MAR) documents staff #1 signature as the staff person administering medications. Staff #1 was unable to provide evidence during the onsite inspection that staff #1 and staff #2 has a license issued by the Commonwealth of Virginia to administer medications or a registration with the Virginia Board of Nursing as a Medication aide.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-90-40-B
Description:	Based on the onsite staff record review and interview, it was determined that the facility failed to ensure the criminal history record report was obtained on or prior to the 30th day of employment for each staff person. Evidence: 1. There was no documentation of a criminal history record completed by the Virginia State Police for staff #1 (date of hire, 04/27/24). 2. There was no documentation of a criminal history record completed by the Virginia State Police for staff #2 (date of hire, 04/27/24).
Plan of Correction:	Not available online. Contact Inspector for more information.