VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Impact Living Services
313 Neff Avenue
Harrisonburg, VA 22801
(434) 533-1088

Current Inspector: Kevin Lassiter (804) 241-2093

Inspection Date: June 7, 2022

Complaint Related: No

Areas Reviewed:

22VAC40-131 ORGANIZATION AND ADMINISTRATION 22VAC40-131 PERSONNEL 22VAC40-131 PROVIDER HOMES 22VAC40-131 CHILDREN?S SERVICES 22VAC40-131 ADDITIONAL REQUIREMENTS FOR SPECIFIC PROGRAMS 22VAC40-191 BACKGROUND CHECKS FOR CHILD WELFARE AGENCIES

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: 06/07/2022 10:52 a.m. to 4:00 p.m. The Acknowledgement of Inspection form was signed and left at the facility each date of the inspection. Number of children in care: One (1), Number of approved provider homes: Four (4). The licensing inspector completed a tour of the physical plant that included the office setting and conditions. Number of children?s records reviewed: One (1), Number of staff records reviewed: Two (2), Number of interviews conducted with staff: One (1). 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 a violation was 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. 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.

Violations:

Standard #:	22VAC40-131-290-C
Description:	Violation: Based on review of the record for foster child FC1 and interview with agency representative AR1, the medical examination report (well child exam) did not document all of the elements required by this standard. Findings: 1. The medical examination report (well child exam) did not document all of the elements required by this standard. 2. Interview with AR1 confirmed that the medical examination report (well child exam) did not document all of the elements required by this standard.
Plan of Correction:	Prior to admission, TFC Program Director will ensure copy of physical exam is obtained and placed in the chart