VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Sunnyside Presbyterian Retirement Community
3935 Sunnyside Drive
Suite B
Harrisonburg, VA 22801-2336
(540) 568-8314

Current Inspector: Jessica Gale (540) 571-0358

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 63.2 PROTECTION OF ADULTS AND REPORTING 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

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: 05/11/2023 and 05/12/2023 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: 66 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 11 Number of staff records reviewed: 6 Number of interviews conducted with residents:5 Number of interviews conducted with staff: 3 Observations by licensing inspector: posting, fire drills, medication pass, medication carts, menus, activities calendar, meals, pharmacy review, dietary review, staff interactions, first aid kits etc. Additional Comments/Discussion: A preliminary review of the violations was completed with the administrator at the end of each day of the inspection. Opportunity was given each day to ask questions and to provide any additional information related to the violations. 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 Rhonda Whitmer, Licensing Inspector at (540) 292-5932 or by email at rhonda.whitmer@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-250-D
Description:	Based on review of staff records, the facility failed to ensure a tuberculosis risk assessment was submitted annually as evidenced by the completion of the current screening form published by the Virginia Department of Health or a form consistent with it. EVIDENCE: 1. The Mantoux (PPD) testing record for staff #2 is dated 10/21/2021. 2. The Tuberculosis Risk Assessment Screening for staff #5 is dated 09/11/2020. 3. The Tuberculosis Risk Assessment Screening for staff #6 is dated 10/04/2021.
Plan of Correction:	An audit will be conducted of all assisted living staff records. A current tuberculosis risk assessment form will be completed on all assisted living staff within the next 7 days including staff #2, staff #5 and staff #6. The nursing coordinator will ensure TB screenings are completed annually in the month of May going forward.
Standard #:	22VAC40-90-40-B
Description:	Based on review of staff records, the facility failed to ensure criminal history reports are obtained on all staff within 30 days of hire. EVIDENCE: The file for staff #27, hired on 03/23/2022 did not contain a criminal history report.
Plan of Correction:	A criminal history report was obtained for staff #27 on 05/12/23. Human Sources will audit all AL staff records to ensure compliance. All new hires will have a criminal history report obtained within 30 days of hire.