VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Williams Luv N Care Home
4012 Elmswell Drive
Richmond, VA 23223
(804) 222-4752

Current Inspector: Shelby Haskins (804) 305-4876

Inspection Date: Sept. 23, 2022

Complaint Related: No

Areas Reviewed:

22VAC40-73 GENERAL PROVISIONS 22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES 22VAC40-73 PERSONNEL 22VAC40-73 STAFFING AND SUPERVISION X 22VAC40-73 ADMISSION, RETENTION AND DISCHARGE OF RESIDENTS X 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 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:

Written interviews regarding room item preferences

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: 9-23-2022, 8:45 ? 11:45 a.m. 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: 8 Number of resident records reviewed: 4 Number of staff records reviewed: 3 Number of interviews conducted with residents: 2 Number of interviews conducted with staff: 1 Observations by licensing inspector: Tour, medication pass, records, emergency supplies 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 Alexandra Poulter, Licensing Inspector at (804)662-9771 or by email at alex.poulter@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-320-A
Description:	Based on record review and interview with staff, the facility failed to ensure within the 30 days preceding admission, a person shall have a physical examination by an independent physician. Evidence: 1. Resident #1 admitted 12-01-2021. Resident #1?s physical examination was dated 01-20-2021, and a later one dated 9-02-2022. 2. Staff #1 confirmed during interview.
Plan of Correction:	Administrator will no longer take residents without proper paperwork.
Standard #:	22VAC40-73-450-C
Description:	Based on record review and interview with staff, the facility failed to ensure the comprehensive ISP (ISP) included a description of identified needs based on the UAI. Evidence: 1. Resident #1 admitted 12-01-2021. Resident #1?s UAI dated 1-12-2022 documented ?human help, supervision? under bathing and dressing; however, the resident?s ISP dated 1-01-2022 only documented ?bathing and dressing? and did not document a description of services to be provided. 2. Resident #3 admitted 03-2016. Resident #3?s UAI dated 5-24-2022 documented the resident needs mechanical help bathing; however, the resident?s ISP dated 8-31-2022 does not address the resident?s bathing need. Staff #1 confirmed the resident uses shower chair and grip bars. 3. Staff #1 confirmed during interview.
Plan of Correction:	Administrator no longer takes resident needing assistance in ADL's such as bathing and will make sure their UAI is updated when their level of care changes. All UAIs and ISPs has been updated.
Standard #:	22VAC40-73-520-I
Description:	Based on observation and interview with staff, the facility failed to ensure that there was a monthly written schedule of activities. Evidence: 1. A current activities calendar for the month of September 2022 was not observed in the facility during inspection. 2. Staff #1 confirmed there was no written schedule of activities for the month of September, 2022.
Plan of Correction:	Administrator has purchased a book to keep monthly scheduled activities in for 2 years.