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: April 19, 2023

Complaint Related: No

Areas Reviewed:

22VAC40-73 RESIDENT CARE AND RELATED SERVICES

Comments:

Type of inspection: Monitoring Date of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 04/19/2023 through 04/28/2023. Documentation and evidence was provided via e-mail from the facility?s licensee. A self-reported incident was received by VDSS Division of Licensing on 04/19/2023 regarding allegations in the area of: resident care and related services. 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 Jennifer Stokes, Licensing Inspector at 540-589-5216 or by email at Jennifer.Stokes@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-680-H
Description:	Based on resident record review, staff interview and licensee interview, the facility failed to ensure that at the time a medication was administered it was documented on a medication administration record (MAR). EVIDENCE: 1. The record for resident 1 contains a physician?s order for Invega Sustenna 117MG inject 0.75ML IM every month for schizoaffective disorder. 2. Notification provided by the facility?s licensee to the regional licensing office, dated 04/13/2023, indicated that when the resident?s March 2023 MAR was being review, there was no signature that the aforementioned medication had been administered to the resident in March 2023. The facility?s licensee indicated that staff 1 stated that the medication had been administered to the resident and the staff person thought he had signed the March 2023 MAR to indicate this; however, staff 1?s initial nor signature were present on the March 2023 MAR.
Plan of Correction:	Action corrected at time of reported violation. Employee (Staff # 1) has been terminated.