VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Babcock Manor, Inc.
State Route 691
Appomattox, VA 24522
(434) 352-8686

Current Inspector: Cynthia Jo Ball (540) 309-2968

Inspection Date: Aug. 12, 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 ARTICLE 1 ? SUBJECTIVITY 32.1 REPORTED BY PERSONS OTHER THAN PHYSICIANS 63.2 GENERAL PROVISIONS 63.2 PROTECTION OF ADULTS AND REPORTING 63.2 LICENSURE AND REGISTRATION PROCEDURES 63.2 FACILITIES AND PROGRAMS 22VAC40-90 BACKGROUND CHECKS FOR ASSISTED LIVING FACILITIES 22VAC40-90 THE SWORN STATEMENT OR AFFIRMATION 22VAC40-90 THE CRIMINAL HISTORY RECORD REPORT 22VAC40-80 THE LICENSE 22VAC40-80 THE LICENSING PROCESS 22VAC40-80 COMPLAINT INVESTIGATION 22VAC40-80 SANCTIONS

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: 08/12/2024 9:45am until 1:00pm 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: 29 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 4 Number of staff records reviewed: 3 Number of interviews conducted with residents: 2 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 Cynthia Ball-Beckner, Licensing Inspector at 540-309-2968 or by email at cynthia.ball@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-120-A
Description:	Based on staff record review and staff interviews, the facility failed to ensure that new staff received orientation and training within the first seven working days of employment. EVIDENCE: 1. The record for staff person 3 did not contain documentation of this employee receiving orientation and training to the facility. In an interview with staff person 4 conducted on the day of inspection, staff person 4 expressed that this employee has been employed for several months.
Plan of Correction:	The administrator will ensure that new employees receive orientation and training as required.
Standard #:	22VAC40-73-250-C
Description:	Based on staff record reviews, the facility failed to ensure that all personal and social data was maintained in staff records, EVIDENCE: 1. The record for staff person 3 did not include the date of hire for this employee or documentation/receipt of the employees job description.
Plan of Correction:	The Administrator will ensure that all employee records contain all required information.
Standard #:	22VAC40-73-450-F
Description:	Based on resident record review, the facility failed to ensure that Individualized service plans (ISP) were updated as needed for a significant change of a resident?s condition. EVIDENCE: 1. The record for resident 1 has documentation that the resident is a high fall risk from the 07/05/2024 fall risk assessment form. The ISP dated 05/27/2024 in the record for resident 1 does not have documentation to address this identified needsor of any services being provided. 2. The record for resident 2 has documentation that the resident is receiving wound care through Hospice services and is a fall risk from the 04/11/2024 fall risk assessment form. The ISP dated 08/06/2023 in the record for resident 2 does not have documentation to address these identified needs or of any services being provided. 3. The record for resident 3 has a physician order dated 07/13/2023 for fall mats and a physician order dated 03/01/2024 for the resident to be in bad at all times. The record also has documentation that Hospice is providing wound care services for a wound to the residents coccyx and right heel. The ISP dated 12/17/2023 in the record for resident 3 does not have documentation to address these identified needs or of any services being provided. 4. The record for resident 4 has a physician order dated 07/13/2023 to use fall mats at all times when resident is in bed and half length bed rails. The record also has documentation that resident 4 is a high fall risk on a fall risk assessment form dated 02/02/2024.The ISP dated 02/02/2024 in the record for resident 24does not have documentation to address these identified needs or of any services being provided.
Plan of Correction:	The administrator will review and update resident ISPs to include all identified needs.
Standard #:	22VAC40-90-30-B
Description:	Based on staff record reviews, the facility failed to ensure that a sworn statement or affirmation was completed for all applicants for employment. EVIDENCE: 1. The record for staff person 3, who is currently employed at the facility, did not contain documentation of a sworn statement or affirmation.
Plan of Correction:	The administrator will ensure that all new employees complete a sworn disclosure statement prior to employment.