VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Henry and William Evans Home
330 East Leicester Street
Winchester, VA 22601
(540) 662-8520

Current Inspector: Kevin Lassiter (804) 241-2093

Inspection Date: June 21, 2022 and June 29, 2022

Complaint Related: No

Areas Reviewed:

22VAC40-151 RESIDENTIAL ENVIRONMENT 22VAC40-151 PROGRAMS AND SERVICES 22VAC40-151 DISASTER OR EMERGENCY PLANNING 22VAC40-80 THE LICENSE

Technical Assistance:

Discussed the date of employment in the records of each employee as noted in the ?Standards for Licensed Children?s Residential Facilities? - 22 VAC 40-151-240.B.6. Discussed all staff being trained in any area of quality improvement as noted in the ?Standards for Licensed Children?s Residential Facilities? - 22 VAC 40-151-250.A.9. Discussed the additional 15 hours applicable to job duties for full-time staff who works with residents as noted in the ?Standards for Licensed Children?s Residential Facilities? - 22 VAC 40-151-250.C. Discussed staff supervision as noted in the ?Standards for Licensed Children?s Residential Facilities? - 22 VAC 40-151-260.3. Discussed discharge information as noted in the ?Standards for Licensed Children?s Residential Facilities? - 22 VAC 40-151-680.E. Discussed behavior support as it pertains to positive and problem behavior as noted in the ?Standards for Licensed Children?s Residential Facilities? - 22 VAC 40-151-800.A.1. Discussed documentation of contact with the home school when a child with a disability has been placed in a residential facility as noted in the ?Standards for Licensed Children?s Residential Facilities? - 22 VAC 40-151-860.D.

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: 6/21/22 from 1:50 PM ? 5:00 PM and 6/22/22 from 10:05 AM ? 4:19 PM. The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. Number of residents in care at the beginning of the inspection: 3 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident?s records reviewed: 2 Number of staff records reviewed: 2 Number of interviews conducted with residents: Resident declined interview Number of interviews conducted with staff: 2 Additional Comments/Discussion: An entrance conference was held on 6/21/22. Reviewed a current resident record and a discharged resident record. Reviewed medication administration records for both residents. Two discrepancies were found with the CRF matrix, which was shared with the IV-E unit for follow-up. Other documentation reviewed during this inspection included, but was not limited to the following: emergency drill documentation, menus, staff work schedules, and daily log entries. The Executive Director and the Program Director were available and accessible during the inspection on both dates. Both were interviewed on 6/22/22 in order to seek clarification about several documents that were reviewed. An exit meeting was conducted on 6/29/22 to review the inspection findings. The evidence gathered during the inspection determined no violations with applicable standard(s) or law. The inspection summary will be posted to the VDSS website within five (5) business days of your receipt of the inspection summary. 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 Michele Freeman, Licensing Inspector at (804) 662-7062 or by email at michele.freeman@dss.virginia.gov