VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Virginia's Assisted Living Facility
1205 Moorman Ave NW
Roanoke, VA 24017
(540) 343-3330

Current Inspector: Angela Marie Swink (276) 623-6575

Inspection Date: Nov. 17, 2020 and Nov. 18, 2020

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 ACCOMODATIONS AND RELATED PROVISIONS 22VAC40-73 BUILDING AND GROUNDS 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.

Technical Assistance:

Please send in the renewal application, ALF addendum, staff information sheet, and annual fee as soon as possible. Your current license expires on 12/13/2020.

Comments:

This inspection was conducted by licensing staff using an alternate remote protocol necessary due to a state of emergency health pandemic declared by the Governor of Virginia. A renewal inspection was initiated on 11/17/2020 and concluded on 11/18/2020. The LPN was contacted by telephone to initiate the inspection. The LPN reported that the current census was 17. The inspector emailed the LPN a list of items required to complete the inspection. The inspector reviewed two resident records, two staff records, background checks on new staff, staff schedules, fire and health department inspections submitted by the facility to ensure documentation was complete. Information gathered during the inspection determined non-compliance(s) with applicable standards or law, and violations were documented on the violation notice issued to the facility.

Violations:

Standard #:	22VAC40-73-450-F
Description:	Based on resident record review, the facility failed to address some resident needs on updated individualized service plans (ISP). EVIDENCE: 1. The fall risk rating dated 2/25/2020 for resident 2 shows this resident is a moderate fall risk, and this is not addressed on the ISP dated 2/4/2020. 2. The uniform assessment instrument (UAI) dated 3/20/2020 for resident 2 shows this person is disoriented to date and time, some of the time and this is not addressed on the ISP dated 2/4/2020. 3. The physical exam form dated 10/25/2019 shows resident 2 is allergic to sulfa and codeine and this is not addressed on the ISP dated 2/4/2020. 4. The UAI dated 9/14/2020 for resident 1 shows this resident needs mechanical and human help with physical assistance when bathing, and the ISP dated 9/14/2020. does not describe the nature of the physical assistance to be given. 5. The UAI dated 9/14/2020 for resident 1 shows this resident needs mechanical and human help with supervision when toileting, and the ISP dated 9/14/2020 shows the resident will be assisted (not-specific) and does not address supervision. 6. The Fall Risk Assessment dated 11/16/2020 for resident 1 shows this resident is a high fall risk, and this is not addressed on the ISP dated 9/14/2020.
Plan of Correction:	1. Fall risk rating has been updated on ISP to reflect moderate risk for resident 2. 2. Orientation status for resident 2 has been updated to reflect current orientation status on ISP. 3. Allergies have been updated to reflect current allergies listed onto ISP for resident 2. 4. Resident 1 ISP updated to reflect current needs with bathing and a description of physical assistance needed. 5. Resident 1 ISP updated to reflect current needs with toileting to include the description of the assistance needed. 6. Fall Risk rating for resident 1 has been updated to reflect the update on 11/16/20. Administrator will audit resident UAI and ISPs weekly to ensure consistency is documented and any changes are updated.
Standard #:	22VAC40-73-970-A
Description:	Based on document review, the facility failed to have fire and emergency evacuation drills in accordance with the current edition of the VIrginia Statewide Fire Prevention Code. Drills are required for each shift in a quarter. EVIDENCE: 1. In the past four months (over a quarter) no fire and emergency evacuation drills have been held on the third shift.
Plan of Correction:	Unable to retro - activate fire drills. Administrator will ensure each shift has completed fire and emergency evacuation drills each quarter.
Standard #:	22VAC40-90-40-B
Description:	Based on staff file review, the facility failed to obtain criminal history record reports on or prior to the 30th day of employment for each employee. EVIDENCE: 1. Staff 2 was hired on 10/7/2019 and the criminal history report was obtained on 1/3/2020. The record show it was requested on 12/12/2019, over two months after staff 2 was hired. 2. Staff 3 was hired on 11/19/2019 and the criminal history report was obtained on 1/3/2020.
Plan of Correction:	Criminal history reports have been obtained on Staff 1 and Staff 3. Administrator will request criminal history reports on all new employees prior to and/or on the first day of employment.