VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Brookdale Harrisonburg
2101 Deyerle Avenue
Harrisonburg, VA 22801
(540) 574-2982

Current Inspector: Jessica Gale (540) 571-0358

Inspection Date: June 2, 2023

Complaint Related: No

Areas Reviewed:

22VAC40-73 RESIDENT CARE AND RELATED SERVICES

Comments:

Type of inspection: Monitoring A self-reported incident was received by VDSS Division of Licensing on 05/31/2023 regarding allegations in the area(s) of: Resident Care and Related Services Number of resident records reviewed: 1 Number of staff records reviewed: 0 Number of staff interviewed: 1 An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation supported the self-report of non-compliance with standard(s) or law, and violation(s) were issued. Any violation(s) not related to the self-report but identified during the course of the investigation can also be found on the violation notice. 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 Rhonda Whitmer, Licensing Inspector at (540) 292-5932 or by email at rhonda.whitmer@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-440-H
Description:	Based on review of resident?s record, the facility failed to ensure a reassessment was completed when a resident has a significant change in condition, using the UAI to determine whether a resident?s needs can continue to be met by the facility and whether continued placement in the facility is in the best interest of the resident. EVIDENCE: 1. The Uniform Assessment Instrument for resident #1, dated 12/19/2022 indicates resident #1 is disoriented to some spheres all of the time. 2. The Uniform Assessment Instrument for resident #1, dated 12/19/2022 indicates resident has appropriate behavior pattern. 3. Progress notes dated 12/01/2022 at 1:57pm indicates ?Resident went outside without informing staff and was found behind the shed. Resident stated he was looking for his truck.? 4. Progress notes dated 02/02/2023 at 5:42 am indicates ?Resident exit seeking this morning looking for his truck, cannot be re-directed.? 5. The LI interviewed staff #1 on 05/31/2023 who confirmed resident #1 has had a significant change in condition.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-450-E
Description:	Based on review of resident?s record and am interview, the facility failed to update the Individualized Service Plan when there is a significant change in the resident?s condition. EVIDENCE: 1. The Individualized Service Plan for resident #1, dated 12/19/2022 does not reflect the current status of the resident. 2. Progress notes dated 12/01/2022 at 1:57pm indicates ?Resident went outside without informing staff and was found behind the shed. Resident stated he was looking for his truck.? 3. Progress notes dated 02/02/2023 at 5:42 am indicates ?Resident exit seeking this morning looking for his truck, cannot be re-directed.? 4. The LI interviewed staff #1 on 05/31/2023 who confirmed resident #1 has had a significant change in condition.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-460-D
Description:	Based on communication received from the facility on 05/31/202, documentation and an interview, the facility failed to ensure supervision of resident?s schedules, care, and activities, including specialized needs, such as prevention of falls and wandering from the premises. EVIDENCE: 1. Communication received from the facility via email on 05/31/2023 indicates resident #1 wandered from the premises on 05/31/2023 at approximately 9:00am. 2. The LI interviewed staff #1 on 05/31/2023 who indicated resident #1 was picked up by a Good Samaritan approximately 0.7 miles from the facility and taken to the local hospital and resident returned to the facility at approximately 10:02am. 3. Progress notes dated 12/01/2022 at 1:57pm indicates ?Resident went outside without informing staff and was found behind the shed. Resident stated he was looking for his truck.? 4. Progress notes dated 02/02/2023 at 5:42 am indicates ?Resident exit seeking this morning looking for his truck, cannot be re-directed. 5. The Uniform Assessment Instrument dated 12/19/2022 indicates resident #1 is disoriented to some spheres all of the time.
Plan of Correction:	Not available online. Contact Inspector for more information.