VIRGINIA DEPARTMENT OF SOCIAL SERVICES

The Haven Assisted Living @ Mayfield
8085 S. Mayfield Lane
Mechanicsville, VA 23111
(804) 779-4847

Current Inspector: Tamara Watkins (804) 662-7422

Inspection Date: March 30, 2022

Complaint Related: No

Areas Reviewed:

22VAC40-73 RESIDENT CARE AND RELATED SERVICES

Comments:

A non-mandated self-report/monitoring inspection was initiated on 3/7/2022 and concluded on 4/5/22. A self-reported incident was received on 2/25/22 by the department regarding allegations in the areas of resident care and related services. A complaint was subsequently received regarding the same issue. The evidence gathered during the investigation supported non-compliance with standards or law, and violations were issued. Any violations not related to the self-report but identified during the course of the investigation can be found on the violation notice. Areas of non-compliance are identified in the Violation Notice. The facility has 10 calendar days from receipt of the inspection reports to complete a plan of correction, sign the inspection report and return them to the licensing office. A copy of the inspection reports shall be retained and posted at the facility. Results of the inspection are subject to public disclosure and will be posted on the VDSS website within 15 calendar days, regardless of whether the plan or correction is completed. The plan of correction shall include the following: (1) Step(s) the facility will take to correct the violations cited; (2) Measures that will be put in place to prevent recurrence of each violation; (3) Person(s) responsible for implementation and monitoring of preventive measures; and (4) Date by which each violation will be corrected.

Violations:

Standard #:	22VAC40-73-460-B
Description:	The facility failed to provide resident centered and personalized care based on the resident's circumstances and preferences. Evidence: Based on a review of an attachment to a progress note (the note was not dated but the resident's name was on the top of the page) listing the preferences and likes for resident #1 the following likes are listed: "likes to walk", "likes to be outside when it is warm", "likes to get mail out of the mailbox". There is no documentation that demonstrates how these preferences were addressed in the resident's plan of care or service delivery. An incident report regarding #1 provided by the facility dated 2/25/22 states "the resident went outside of the facility and started walking down the road". "A neighbor found the resident and returned her to the facility". The resident's UAI dated 5-1-21 states "walking needs supervision". The resident has a diagnosis "moderately severe dementia" on a physical examination dated 3/28/2019.
Plan of Correction:	The Administrator will ensure ALL personalized care for each resident will be updated on the plan of care. 4/8/2022
Standard #:	22VAC40-73-460-D
Description:	The facility failed to provide supervision of the residents care and activities, including attention to specialized needs, such as wandering from the premises. Evidence: An incident report dated 2/25/22 states the "resident went outside of the facility and started walking down the road". "A neighbor found the resident and returned her to the facility". The UAI for resident #1 dated 5-1-21 states "walking needs supervision" and "disoriented some spheres some of the time (time and place). The resident has a diagnosis "moderately severe dementia" on a physical examination dated 3/28/2019. The ISP for resident #1 dated 5-1-21 with a target date of 5-1-22 lists Need-Disoriented; Description of services to be provided - Resident will be monitored at all times and re-directed if needed; Person who will provide - Direct Care Staff; When and Where services will be provided- Daily at the facility, PRN; Expected Outcomes and Date of Expected Outcomes - Resident will be safe at all times and cared for appropriately, will address issues as needed. 5/1/22. The ISP is not specific as to how the facility will provide for the residents safety, what is meant by cared for appropriately, and will address issues as needed. Supervision is not addressed.
Plan of Correction:	Care staff will ensure doors to the facility are locked when assisting residents with bathroom needs. 2/25/2022