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 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: 08/01/2024 7:40am to 12:30pm and 08/05/2024 3:06pm to 4:07pm 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: 14 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 2 Number of staff records reviewed: 2 Number of interviews conducted with residents: 3 Number of interviews conducted with staff: 2 Observations by licensing inspector: Noon meal, medication pass Additional Comments/Discussion:
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 Becky Berry, Licensing Inspector at 276-608-3514 or by email at rebecca.berry@dss.virginia.gov.
Based on a review of resident records, the facility failed to ensure medications shall be administered in accordance with the physician's or other prescriber?s instructions. EVIDENCE: 1. Per the physician?s order dated 06/01/2022 and the July 2024 medication administration record (MAR), resident #3 has an order for Metoprolol Tartrate 50mg Tab, with the following instructions: Take 1 tablet by mouth 2 times a day for htn (hold for blood pressure (BP) <130/70 or pulse <60). 2. According to the Blood Pressure Check form used by the facility to record blood pressure readings and pulse rates and the July 2024 MAR, the medication was administered to resident #3 the following dates/times when the systolic blood pressure reading was less than 130: 07/09/2024, 7pm (BP 124/87), 07/13/2024, 7am (BP 121/75), 07/13/2024, 7pm (BP 120/84), 07/20/2024, 7am (BP 122/79) and 07/27/2024, 7pm (BP 121/77).
Plan of Correction:
In the future when receiving blood pressure checks order, the Med Teck and or Administrator will get either/or clarification of new blood pressure check order. [SIC]
Standard #:
22VAC40-73-870-D
Description:
Based on interviews with residents and staff, the facility failed to ensure buildings shall be kept free of infestations of insects and vermin. EVIDENCE: 1. Residents #1, #5 and #4 reported seeing mice on multiple occasions in the common area on the main level, next to the dining area. 2. Staff #3 and #1 confirmed an issue with mice in the facility.
Plan of Correction:
Dotson Pest Control has already been contacted and had put out devices for infestation. ALF will continually monitor. [SIC]
Standard #:
22VAC40-73-870-E
Description:
Based on observations made during a tour of the building, the facility failed to ensure that all furnishings, fixtures, and equipment, including furniture, window coverings, sinks, toilets, bathtubs, and showers, shall be kept clean and in good repair and condition. EVIDENCE: 1. In the blue bathroom, there appeared to be several layers of caulking around three sides of the bathtub that were dirty and stained, especially in the area of the water knobs and spigot. 2. The paint on the back wall of the bathtub in the blue bathroom was peeling and had areas of what appeared to be rust stains. 3. The area where the wall meets the bathtub in the blue bathroom on the side of the spigot appeared to have water damage, and the baseboards below were dirty/stained, and the paint on the moulding at the other end of the bathtub, near the toilet, was peeling. 4. There was a 3-4 inch slit in the flooring in front of the toilet in the blue bathroom. 5. The paint on the moulding by the base of the bathtub in the bathroom across and down the hall from the blue bathroom was peeling.
Plan of Correction:
In the future the Administrator/Owner will follow-up daily to see that proper housekeeping has been done on all shifts. [SIC]
Disclaimer:
This information is provided by the Virginia Department of Social Services, which neither endorses any facility nor guarantees that the information is complete. It should not be used as the sole source in evaluating and/or selecting a facility.
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http://www.dss.virginia.gov/facility/search/alf.cgi