Covenant Columns
510 Park Avenue
Richmond, VA 23223
(804) 222-5133
Current Inspector:
Shelby Haskins
(804) 305-4876
Inspection Date:
June 24, 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 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
Comments:
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: 11
The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 6 Number of staff records reviewed: 3 Number of interviews conducted with staff: 2
Observations by licensing inspector: A tour of the facility was conducted to include inside and outside building grounds. Residents were being served Breakfast and were exercising (from an exercise video) during the inspection. The weekly menu and resident activities were observed. The morning medication pass observation was completed. The following was reviewed: resident and staff records, emergency preparedness drills, resident fire and resident emergency drills, medication carts, fire inspection report, health inspection report, and a staffing schedule.
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 Shelby Haskins, Licensing Inspector at (804) 305-4876 or by email at Shelby.Haskins@dss.virginia.gov.
Based on a review of resident records, it was determined that the facility did not ensure that all residents have a risk assessment for tuberculosis (TB) shall be completed annually on each resident as evidenced by the completion of the current screening form published by the Virginia Department of Health or a form consistent with it.
Evidence: 1. The record for resident #4 contained a tuberculosis (TB) assessment that was dated 4/19/23. 2. The record for resident #5 file contained tuberculosis (TB) assessment that was dated 04/19/2023. 3. Staff #1 reviewed the records for resident #4 and resident #5 and confirmed that the annual Tuberculosis (TB) Assessment had not been completed.
Plan of Correction:
Facility will review the TB assessments for Resident #4 and #5 and ask the physician to provide the updated TB form.
Standard #:
22VAC40-73-440-A
Description:
Based on a review of resident records, it was determined that the facility did not ensure that all residents of the facility shall be assessed face to face using the Uniform Assessment Instrument (UAI) in Assisted Living Facilities (22VAC30-110). The UAI shall be completed prior to admission, at least annually, and whenever there is a significant change in the resident?s condition.
Evidence: 1. The record for resident #1 contained a Uniform Assessment Instrument (UAI) that was dated for 05/30/2023. 2. The record for resident #5 contained a Uniform Assessment Instrument (UAI) that was dated for 01/19/2023. 3. Staff # 1 reviewed the records for resident #1 and resident #5 and confirmed that the annual update for the Uniform Assessment Instrument (UAI) had not been completed for each resident
Plan of Correction:
The resident UAI was missed to be signed for the latest date. The facility will review the UAI for resident #1 and #5 and sign them with appropriate dates. Going forward the facility will ensure that new UAI forms are used and the dates are correctly put along with the administrator?s signature.
Standard #:
22VAC40-73-450-E
Description:
Based on a review of resident records, it was determined that the facility did not ensure that all residents have a individualized service plan (ISP) signed and dated by the licensee, administrator, or his designee and by the resident, or his legal representative. This plan shall also indicate any other individuals who contributed to the development of the plan, with a notation of the date of contribution. The title or relationship to the resident of each person who was involved in the development of the plan should be included. The requirements shall also apply to reviews and updates of the plan.
Evidence: 1. The record for resident #5 contained an individualized service plan (ISP) that was not signed and dated by the licensee, administrator, or his designee and by the resident, or his legal representative. 2. Staff #1 reviewed the record for resident #5, and confirmed it did not contain the required signatures.
Plan of Correction:
Facility will review the ISP for resident #5 and ensure that it is complete and correct as per the UAI and signed by the administrator.
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.
Find this content at:
http://www.dss.virginia.gov/facility/search/alf.cgi