VIRGINIA DEPARTMENT OF SOCIAL SERVICES

The Culpeper
12425 Village Loop
Culpeper, VA 22701-4375
(540) 825-2411

Current Inspector: Jeffrey Marnien (540) 571-0189

Inspection Date: May 18, 2023 and May 19, 2023

Complaint Related: No

Areas Reviewed:

Administration and Administrative Services Personnel Staffing and Supervision Admission, Retention and Discharge of Residents Resident Care and Related Services Buildings and Grounds Emergency Preparedness Mixed Population Safe, Secure Environment

Comments:

Date of Inspection: May 18 and 19, 2023 Type of Inspection: Renewal Inspection If you have any questions or email changes, please do not hesitate to contact me at laura.lunceford@dss.virginia.gov. If you need a copy of any of the DSS Model forms or to review any inspection or regulation, you can find the information on the internet: www.dss.virginia.gov. Census 84 Number of records reviewed and interviews conducted- 11 records (staff and residents), 13 interviews. All facility self-reported incidents since the last inspection were reviewed on this date. The Licensing Inspector observed the residents during meal times and activities. The Licensing Inspector reviewed the following at the time of inspection: activities calendars, menus, fire drills, pharmacy review, and health care oversight.

Violations:

Standard #:	22VAC40-73-450-D
Description:	Based on resident record review and staff interview, it was determined that the facility failed to have a coordinated plan of care with the Hospice agency on the Individualized Service Plan (ISP) as required. Evidence: Resident Bs ISP dated January 10, 2023 and Resident Cs ISP dated March 14, 2023 had no documentation of a coordinated plan of care between the facility and the Hospice agency.
Plan of Correction:	The residents ISPs were corrected at the time of inspection. All ISPs will reflect a coordinated plan of care for hospice. The nursing staff will audit the records to ensure compliance.