VIRGINIA DEPARTMENT OF SOCIAL SERVICES

The Harmony Collection at Roanoke Independent Living
4428 Pheasant Ridge Road
Roanoke, VA 24014
(540) 400-6482

Current Inspector: Holly Copeland (540) 309-5982

Inspection Date: Dec. 20, 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: 12/20/2023 from 09:00 AM until 03:30 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 #:	22VAC40-73-430-H-1
Description:	Based on record review and staff interview, the facility failed to ensure that at the time of discharge, the assisted living facility shall provide to the resident and, as appropriate, his legal representative and designated contact person a dated statement signed by the licensee or administrator that contains the date that the resident, or other, was notified of the planned discharge and who was notified; the reason or reasons for the discharge; the actions taken by the facility to assist the resident in the discharge and relocation process; and the date of the actual discharge from the facility and the resident?s destination. EVIDENCE: 1. During the inspection on 12/20/2023, the facility provided documentation for resident 2 and stated that this record was for a discharged resident who had been discharged for more than 60 days prior to the date of inspection; however, the documentation for resident 2 did not contain a written and signed discharge statement. 2. During the exit interview, staff were unable to produce a written and signed discharge statement for resident 2.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-450-C
Description:	Based on record review and staff interview, the facility failed to ensure that the comprehensive individualized service plan (ISP) contained a description of identified needs and date identified based on the UAI, as well as a written description of what services will be provided to address identified needs, and who will provide them. EVIDENCE: 1. The uniform assessment instrument (UAI) for resident 4, dated 09/13/2023, indicates that the resident is disoriented to some spheres, some of the time (with time, situation, and date affected); however, the disorientation was not addressed in this resident?s individualized service plan (ISP), dated 09/13/2023. 2. The record for resident 5 contained therapy notes certifying occupational therapy from 11/02/2023 through 12/27/2023 and notes certifying speech therapy from 11/01/2023 through 12/26/2023; however, neither therapy service was included in this resident?s ISP, dated 09/17/2023. 3. The UAI for resident 5, dated 09/17/2023, indicates that this resident is disoriented to some spheres some of the time (with place and time affected); however, disorientation was not addressed in this resident?s ISP, dated 09/17/2023. 4. During the exit interview on 12/20/2023, staff were unable to provide verification that these needs and services were addressed on the ISPs for resident 4 and resident 5.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-550-G
Description:	Based on record review and staff interview, the facility failed to ensure that the rights and responsibilities of residents in assisted living facilities shall be reviewed annually with each staff person. EVIDENCE: 1. The record for staff 2, date of hire 08/03/2022, did not contain documentation of having received a resident rights review since 2022. 2. During the exit interview on 12/20/2023, staff were unable to provide documentation that staff 2 has had an annual resident rights review in 2023.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-680-D
Description:	Based on record review and staff interview, the facility failed to ensure that medications shall be administered in accordance with the physician?s or other prescriber?s instructions. EVIDENCE: 1. The record for resident 6 contains signed physician?s orders for HUMALOG KWIKPEN 100U/mL sliding scale insulin injections based on the results of blood sugar checks before meals and at bedtime. If blood sugar results indicate 150-199, give 2 units of insulin; 200-249, give 3 units; 250-299, give 4 units; 300-349, give 6 units; 350 or greater, call MD. 2. The December 2023 medication administration record (MAR) for resident 6 indicated that on 12/06/2023 at 07:00 PM, the blood sugar reading was 175 and that 3 units of insulin were administered (instead of 2 units per sliding scale). On 12/10/2023 at 07:00 PM, the blood sugar reading was 99 and that 2 units were administered (instead of not administering insulin per sliding scale).
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-970-A
Description:	Based on record review and staff interview, the facility failed to ensure that fire and emergency evacuation drills shall occur for each shift in a quarter. EVIDENCE: 1. According to the facility?s fire drill documentation, the facility operates on 1st, 2nd, and 3rd shifts (8-hour). 2. For the most current quarter of 2023 (Oct, Nov, Dec), staff could not provide documentation that a fire drill occurred on any shift in November 2023.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-90-40-B
Description:	Based on documentation review and staff interview, the facility failed to ensure that the criminal history record report shall be obtained on or prior to the 30th day of employment for each employee. EVIDENCE: 1. The new staff documentation provided revealed that staff 4 was hired on 02/28/2023; however, the criminal history record report for that staff member was completed on 11/29/2023. 2. During the exit interview on 12/20/2023, staff were unable to provide verification that staff 4 received a criminal history record report within 30 days of hire.
Plan of Correction:	Not available online. Contact Inspector for more information.