VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Riverside Assisted Living at Smithfield
101 John Rolfe Drive
Smithfield, VA 23430
(757) 357-3282

Current Inspector: Donesia Peoples (757) 353-0430

Inspection Date: Oct. 28, 2022

Complaint Related: No

Areas Reviewed:

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 EMERGENCY PREPAREDNESS 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS 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: An unannounced monitoring inspection took place on 10/28/22 from 9:19am to 1:35pm. The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. A self-reported incident was received by VDSS Division of Licensing on 10/11/2022 regarding allegations in the area of: Resident Care and Related Services Number of residents present at the facility at the beginning of the inspection: 58 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 1 Number of staff records reviewed: 2 Number of interviews conducted with residents: 1 Number of interviews conducted with staff: 1 Observations by licensing inspector: The licensing inspector reviewed emergency preparedness procedures, documentation of staff rounds, and observation of the outside grounds to include the nursing facility where the resident was located. Additional Comments/Discussion: None An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation supported the self-report of non-compliance with standard(s) or law, and violation(s) were issued. Any violation(s) not related to the self-report but identified during the course of the investigation can also be found 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 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 #:	22VAC40-73-325-A
Description:	Based on the onsite record review, the facility failed to ensure for residents who meet the criteria for assisted living care, by the time the comprehensive individualized service plan (ISP) is completed, a written fall risk rating shall be completed. Evidence: 1. The record of Resident #1 did not include documentation of a fall risk rating. 2. The ISP for Resident #1 dated 06/01/22 documents the resident is at risk for falls.
Plan of Correction:	1. Nurse Manager completed a fall risk rating on Resident #1 on 10/12/2022 2. Nurse Manager or designee will complete a 100% audit of all current residents for fall risk completion, by 12/15/22 3. Nurse Manager/designee will educate the staff on ensuring that resident ISP have complete fall risk assessments and are updated as needed. 4. An audit of 3 new admission records will be completed by nurse manager/designee weekly for 8 weeks. 5. All corrected actions will be completed by 12/23/22
Standard #:	22VAC40-73-410-A
Description:	Based on the record review the facility failed to ensure upon admission, the assisted living facility shall provide an orientation for new residents and their legal guardian including emergency response procedures, mealtimes, and use of the call system. Acknowledgement of receiving the orientation shall be signed and dated by the resident and, as appropriate his legal guardian, and such documentation shall be kept in the resident?s record. Evidence: 1. Resident # 1 record did not include documentation of an orientation upon his admission date of 06/01/22.
Plan of Correction:	1. Director of Marketing and Resident Services has completed a notification of orientation with Resident #1 completed on 10/18/22 2. Nurse Manager or designee will complete a 100% audit of all current residents for notification of orientation by 12/15/22. 3. Nurse Manager/designee will educate the staff on ensuring the resident has notification of orientation completed upon admission. Administrator/designee will review admission packet to ensure notification of orientation is included in the template. 4. An audit of 3 new admission records will be completed for notification of orientation weekly by nurse manager/designee weekly for 8 weeks. 5. All corrected actions will be completed by 12/23/22
Standard #:	22VAC40-73-450-E
Description:	Based on the record review, the facility failed to ensure the ISP shall be signed and dated by the resident or the legal guardian. Evidence: 1. In the record for resident #1, the ISP dated 06/01/22 did not include a signature of the resident or legal guardian.
Plan of Correction:	1. Nurse Manager/Designee will review the ISP with Resident #1?s representative and obtain a signature by 11/25/22 2. Nurse Manager or designee will complete a 100% audit of all current residents to check for signature on ISP, completed by 12/15/22 3. Nurse Manager/designee will educate staff on ensuring the resident ISPs have a signature. 4. An audit of 3 new admission records will be completed by nurse manager/designee weekly for 8 weeks. 5. All corrected actions will be completed by 12/23/22
Standard #:	22VAC40-73-460-D
Description:	Based on staff interview and the onsite record review the facility failed to provide supervision of resident schedules, care, and activities including attention to specialized needs, and wandering from the premises. Evidence: 1. An incident report for Resident #1 dated 10/18/22 documents at approximately 3:30 am the resident was found outside knocking on the attached nursing home door. The incident report documented the resident was last seen by staff #1 in the facility at 2:00 am. 2. Staff #2 acknowledged the staff on duty was not aware resident #1 left the facility. 3. Resident #1 physical exam report dated 05/24/22 documents a diagnosis of Unspecified Dementia. 4. Resident #1 ISP dated 06/01/22 documents the resident is disoriented to some spheres to include place and situation.
Plan of Correction:	1. Resident #1 was re-evaluated the provider and was transferred to the memory care unit on 10/12/22 after the attempt to leave the building. 2. An audit of resident elopement risk evaluations will be completed by the nurse manager/designee by 11/30/22. Resident ISPs will be updated by the nurse manager/designee, if indicated. 3. The Nurse Manager/designee will educate the nursing staff on the process for completing elopement risk evaluations on admission, annually, and as needed. 4. The nurse manager/designee will audit of 3 records weekly for 8 weeks to ensure the elopement risk evaluation was completed. 5. All actions will be completed by 12/23/22.