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: March 5, 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

Comments:

A (self-reported incident) was received by VDSS Division of Licensing on (02/18/2024) regarding allegations in the area(s) of: Resident Care and Related Services Number of residents present at the facility at the beginning of the inspection: 54 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: 0 Number of interviews conducted with staff: 3 Observations by licensing inspector: An observation of the facility?s exit doors and exit alarm signals was completed. An observation of the outside grounds and the road in which the facility is located was completed. A review of the facilities emergency drills were completed. 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 #:	22VAC40-73-460-D
Description:	Based on the record review and staff interview the facility failed to ensure the facility shall provide supervision of resident schedules, care, and activities, including attention to specialized needs such as prevention of falls and wandering from the premises. Evidence: 1. Resident?s #1 incident report dated 02/18/24 includes the following for the date of 02/16/24 at 11:30 pm: ?staff heard the alarm sound, immediately began doing room rounds, and noted resident was not in their room, resident was found outside with their wanderguard and project lifesaver bracelet on.? 2. Resident?s #1 progress note dated 02/16/24 documents the following: ?resident exited out of the building and was found up the road.? 3. Resident?s #1 record contains a description of event for 02/16/24 that documents the following: ?staff was assisting another resident with care. Staff noted south hall door alarm going off. Staff immediately started doing rounds. Resident was noted to not be in their room. Resident was found down the road walking with only a night gown on. Resident was noted to not be wearing any shoes or socks.? 3. During an interview with staff #1, staff #1 reported the following: On 02/16/24, staff #1 was in the car driving and saw resident #1 walking up the road, staff #1 located resident #1 at the stop sign (located on the street, Breanna Court) up the road from the facility, staff #1 assisted resident #1 with getting in the car and staff #1 drove resident #1 back to the facility. Staff #1 reported during the time of resident?s #1 elopement from facility, staff #2 was the only staff person working in the assisted living facility section of the building. 4. Resident #1 was admitted to the assisted living section of the facility on 02/16/24. Resident?s #1 Individualized Service Plan (ISP) dated 02/16/24 documents a need for a wanderguard to be in place. Resident #1?s physical examination dated 01/04/24 documents ?Dementia is the most significant health issue.? The physical exam documents the resident?s diagnosis as ?Alzheimer?s Disease, Unspecified.? Resident?s #1 uniform assessment instrument (UAI) dated 02/06/24 documents the resident?s orientation as ?disoriented, some spheres.?
Plan of Correction:	Resident #1 was moved Into the secured memory care unit on 03/15/24. Will review residents being admitted into assisted living to ensure they are qualified for AL or if they are needing memory care prior to admission. Al Director will educate Marketing Director on importance of ensuring potential residents are coming into the facility are screened for elopement prior to admission and families are present and getting full history of resident along with reviewing H&P from provider. Will review 2 admissions weekly to ensure that those being admitted to assisted living or memory care are appropriate. The results of the audits will be given to AL Director and Administrator to review and results will be presented at QAPI