VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Countryside Assisted Living, LLC
1240 Orange Road
Pratts, VA 22731
(540) 948-6318

Current Inspector: Jessica Gale (540) 571-0358

Inspection Date: June 18, 2020

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 EMERGENCY PREPAREDNESS 22VAC40-90 Background Checks for Assisted Living Facilities 22VAC40-90 The Sworn Statement or Affirmation 22VAC40-90 The Criminal History Record Report

Technical Assistance:

Please provide a copy of your fire inspection following release from the health pandemic.

Comments:

This inspection was conducted by licensing staff using an alternate remote protocol necessary due to a state of emergency health pandemic declared by the Governor of Virginia. A monitoring inspection was initiated on 6/17/2020 and concluded on 6/18/2020. The administrator and director of nursing were contacted by email to initiate the inspection. The administrator reported that the current census was 17. The inspector emailed the administrator a list of things required to complete the inspection. The inspector reviewed two resident charts including notes and two additional medication records with physician orders. Two staff records were reviewed that included training, any certification requirements and staff scheduling. Background checks for staff hired since last inspection were also reviewed. The inspection also included review of fire and health inspections, emergency drills, health care over site all submitted by the facility to ensure documentation was complete. The only special diet is reviewed presently by the nurse practitioner. The information gathered during the inspection determined no violations with applicable standards or laws. No violations were issued. Thank you to staff and administration for your patience and assistance during this desk review process. Should you have additional questions or concerns please call (540) 332-2330 or e-mail this inspector at sharon.deboever@dss.virginia.gov.