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: Nov. 15, 2023

Complaint Related: No

Areas Reviewed:

22VAC40-73 GENERAL PROVISIONS 22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES 22VAC40-73 PERSONNEL 22VAC40-73 STAFFING AND SUPERVISION 22VAC40-73 ADMISSION, RETENTION AND DISCHARGE OF RESIDENTS 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 22VAC40-90 THE SWORN STATEMENT OR AFFIRMATION 22VAC40-90 THE CRIMINAL HISTORY RECORD REPORT

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: 11/15/2023 from 09:00 AM until 03:15 PM The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. 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 Holly Copeland, Licensing Inspector at 540-309-5982 or by email at holly.copeland@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-260-A
Description:	Based on staff record review and staff interview, the facility failed to ensure that each direct care staff member shall maintain current certification in first aid. EVIDENCE: 1. During an on-site inspection on 11/15/2023, the record for staff 4 indicated the date of hire was 11/5/2021. 2. The record for staff 4 did not contain documentation of current certification in first aid. 3. During an interview with two Licensing Inspectors (LIs), staff 5 indicated there was no documentation of current certification in first aid for staff 4.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-440-D
Description:	Based on resident record review and staff interview, the facility failed to ensure that the Uniform Assessment Instrument (UAI) is completed as required by 22VAC30-110 with the assessment, including functional status. EVIDENCE: 1. During the on-site inspection on 11/15/2023, the UAI in the record for resident 3, dated 10/9/2023, indicated that mechanical and physical assistance is needed for walking; however, the Individual Service Plan (ISP) in the record for resident 3, dated 10/13/2023, did not identify if assistance is needed with walking. In addition, the UAI in the record for resident 3 indicated that assistance is needed for eating/feeding though it did not specify the type of assistance needed; however, the ISP in the record did not identify the resident?s need for eating/feeding assistance. 2. During an interview with two Licensing Inspectors (LIs), staff 5 revealed that the ISP for resident 3 is accurate as the resident does not walk and that the resident does not need assistance with eating/feeding. 3. During the on-site inspection on 11/15/2023, the ISP in the record for resident 1, dated 9/28/2023, indicated that the resident needs supervision for eating/feeding; however, the UAI in the record for resident 1, dated 9/6/2023, indicated that resident 1 does not require assistance for eating/feeding. 4. During an interview with two LIs, staff 5 revealed that the ISP for resident 1 is accurate as the resident does need supervision for eating/feeding.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-450-C
Description:	Based on resident record review and staff interview, the facility failed to ensure the comprehensive Individualized Service Plan (ISP) contained all identified needs from all sources. EVIDENCE: 1. During an on-site inspection on 11/15/2023, the UAI for resident 3, dated 10/9/2023, indicated that the resident is incontinent of bladder less than weekly; however, the ISP for resident 3, dated 10/13/2023, indicated that resident is continent of bladder and can take care of personal bladder needs. 2. During an interview with two licensing inspectors (LIs), staff 5 revealed that the UAI for the resident is accurate as the resident is incontinent of bladder less than weekly. 3. During an on-site inspection on 11/15/2023, the UAI for resident 1, dated 9/6/2023, indicated that the resident needs mechanical and physical assistance for wheeling and that stairclimbing is not performed; however, the ISP for resident 1, dated 9/28/2023, indicated that the resident needs mechanical help only for wheeling and needs mechanical and physical assistance for stairclimbing. 4. During an interview with two LIs, staff 5 revealed that the UAI for resident 1 is accurate as the resident needs mechanical and physical assistance for wheeling and that stairclimbing is not performed. 5. Prior to providing LIs an evidentiary copy of the ISP for resident 1, staff 5 updated the ISP by handwriting in additional information. 6. The UAI for resident 6, dated 5/4/2023, indicated that the resident requires mechanical and physical assistance for transferring; however, the ISP for resident 6, dated 5/4/2023, does not address the resident?s need for assistance when transferring. 7. During an interview with two LIs, staff 5 revealed that the UAI accurately reflects the transferring needs of resident 6. 8. The REVIEW OF APPROPRIATENESS OF CONTINUED RESIDENCE IN SPECIAL CARE UNIT form for resident 5 indicated placement in the special care unit on 3/6/2023 due to a dementia diagnosis and the inability to recognize danger. In addition, the ISP for resident 5, dated 3/6/2023, indicated that the resident resides in the secure unit due to dementia and inability to recognize danger; therefore, staff will provide monitoring services. Alternately, the ISP for resident 5 does not indicate if the resident has the inability to use the signaling device and if direct care staff will perform and document safety checks at least every two hours once the resident has gone to bed each evening until the resident has arisen each morning. 9. During an interview with two LIs, staff 5 was unable to confirm if resident 5 can use the call bell system despite having a diagnosis of dementia, nor able to confirm if safety checks are being performed as a result.
Plan of Correction:	Not available online. Contact Inspector for more information.