VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Hairston Home for Adults
601 Armstead Ave
Martinsville, VA 24112
(276) 638-5121

Current Inspector: Angela Marie Swink (276) 623-6575

Inspection Date: Feb. 22, 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 22VAC40-90 BACKGROUND CHECKS FOR ASSISTED LIVING FACILITIES 22VAC40-90 THE SWORN STATEMENT OR AFFIRMATION 22VAC40-90 THE CRIMINAL HISTORY RECORD REPORT

Comments:

Type of inspection: Renewal Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 2.22.2024 8:30am to 2:15pm 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: 31 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 6 Number of staff records reviewed:3 Number of interviews conducted with residents: 4 Number of interviews conducted with staff: 3 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 A Marie Swink, Licensing Inspector at 276-635-6575 or by email at marie.swink@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-260-A
Description:	1.The record for staff 1, date of hire 3/7/2022 as direct care staff, did not contain a certification in first aid. 2.The record for staff 2, date of hire 4/29/2019 as direct care staff, contained an American Heart Association Basic Life Support certificate that had a renew by date of August 2023. The record did not contain a current certification in first aid. 3.During the on-site inspection on 2/22/2024, an interview conducted with one Licensing Inspector and staff person 3, staff person 3 revealed the record for staff 1 and staff 2 was current.
Plan of Correction:	First Aid/CPR classes are waiting for schedule date. Class will be scheduled within 30 days.
Standard #:	22VAC40-73-310-B
Description:	Based on resident record review and staff interview, the facility failed to ensure a documented interview between the administrator, the individual, and his legal representative was completed to determination that the facility can meet the needs of the individual. EVIDENCE: 1.The record for resident 1, admitted on 1/17/2024, did not contain a documented interview. 2.During the on-site inspection on 2/22/2024, an interview conducted with one Licensing Inspector and staff person 3, staff person 3 revealed a documented interview was not completed for resident 1.
Plan of Correction:	Interview Sheet is added to orientation packet. Interview sheets will be completed for residents missing in file.
Standard #:	22VAC40-73-610-B
Description:	Based on physical plant observation and staff interview, the facility failed to ensure menus for meals and snacks for the current week are posted in an area conspicuous to residents. EVIDENCE: 1.One licensing inspector did not observe a posted menu for meals and snacks for the current week. 2.During the on-site inspection on 2/22/2024, an interview conducted with one Licensing Inspector and staff person 4, staff person 4, staff person 4 revealed the menu was not posted.
Plan of Correction:	Menu posted the day of inspection.