VIRGINIA DEPARTMENT OF SOCIAL SERVICES

The Harmony Collection at Roanoke Memory Care
4414 Pheasant Ridge Road
Roanoke, VA 24014
(540) 685-4900

Current Inspector: Holly Copeland (540) 309-5982

Inspection Date: July 11, 2023

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 PERSONNEL 22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS 22VAC40-80 COMPLAINT INVESTIGATION

Comments:

Type of inspection: Complaint # 57558 Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 07/11/2023 from 09:30 AM until 12:30 PM The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. A complaint was received by VDSS Division of Licensing on 05/01/2023 regarding allegations in the area(s) of: Personnel and provision of resident care and related services. Number of residents present at the facility at the beginning of the inspection: 34 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 1 Number of staff records reviewed: N/A Number of interviews conducted with residents: N/A Number of interviews conducted with staff: 2 Observations by licensing inspector: N/A Additional Comments/Discussion: N/A An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation did not support the allegations of non-compliance with standard(s) or law. However, violation(s) not related to the complaints but identified during the course of the investigation can 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 Holly Copeland, Licensing Inspector at 540-309-5982 or by email at holly.copeland@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-70-C
Complaint related:	No
Description:	Based on record review and staff interview, the facility failed to ensure that a written incident report was submitted to the regional licensing office within seven days from the date of an incident that is signed and dated by the administrator and includes all required information as indicated in this regulation. EVIDENCE: 1. On 05/01/2023, LI was notified by a complainant that a resident emergency had occurred at the facility with resident 1 on 04/29 and that resident 1 was in a specified hospital receiving a change in his psychiatric medication. 2. While completing an on-site follow up inspection, LI reviewed progress notes for resident 1 which indicated that on 04/29/2023 around 08:40 AM, resident 1 was in the room for resident 2 and was taking resident 2?s clothes off and threatening staff and swinging a pair of pliers. Staff 1 and 911 were notified and when staff 1 arrived at the facility, resident 1 was found in his room sitting on the side of his own bed. Progress notes indicate that staff 1 contacted the responsible party (RP) for resident 1 to advise her of the situation. The RP for resident 1 told staff 1 for the facility to get a sitter for resident 1 or to send him to a specified hospital for psychiatric care. The resident was ultimately transported to the specified hospital without incident by staff 1 on the same day due to the inability of the facility to obtain emergency transportation services after trying to contact several transport agencies, per resident 1 progress notes. 3. An interview with staff 1 and staff 2 during an on-site follow-up on 07/11/2023 detailed the same information as was documented in the progress notes for resident 1; however, neither staff 1 nor staff 2 could confirm that an incident report was completed and sent to the regional licensing office or the LI within seven days of the incident.
Plan of Correction:	Not available online. Contact Inspector for more information.