VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Alpha House II
3903 West Autumn Drive
Petersburg, VA 23803
(804) 861-0533

Current Inspector: Irvin Goode (804) 543-5188

Inspection Date: May 30, 2019 and May 31, 2019

Complaint Related: No

Areas Reviewed:

22VAC40-151 22VAC40-151 III. RESIDENTIAL ENVIRONMENT 22VAC40-151 PROGRAMS AND SERVICES 22VAC40-151 PROGRAMS AND SERVICES 22VAC40-151 DISASTER OR EMERGENCEY PLANNING

Technical Assistance:

Discussed staff training in any area of quality improvement as it pertains to the quality improvement plan as noted in standard 250.A.9. Discussed personal necessities for the purposes of hygiene and grooming as noted in standard 410. Discussed documentation for mattresses as noted in standard 420.H. Discussed discharge information provided to the resident?s legal guardian and the model form developed by the department as it pertains to standard 680.E. Discussed discharge summaries in regard to the resident?s progress toward meeting the service plan objectives and the model form developed by the department as it pertains to standard 680.G.1.b. Discussed structured program of care as it pertains to a resident?s emotional needs as noted in standard 720.A.1. Discussed the daily diet for residents as noted in standard 760.A. Discussed opportunities for group activities as noted in standard 880.A.1.

Comments:

An unannounced monitoring inspection was completed by the Licensing Specialist on 5/30/19 from 9:00 a.m. to 5:08 p.m. and 5/31/19 from 9:01 a.m. to 3:49 p.m. The current census is three (3) residents. The following is a listing of the activities for this inspection: Reviewed one current resident record and one discharged resident record. Reviewed two medication administration records. Two personnel records were reviewed. No discrepancies were found with the CRF matrix. Two staff and two residents were interviewed. An inspection of the interior and exterior of the facility was completed. Other documentation reviewed during this inspection included, but was not limited to the following: emergency drill documentation, menus, and staff work schedules. The Program Director (PD) was available and accessible during the inspection. An Exit Interview to review preliminary findings was conducted with the PD at approximately 1:31 p.m. on 5/31/19. The Acknowledgement of Inspection form was signed and left at the facility. Upon receipt of this violation notice, a plan of correction is requested for each violation. The Plan of Correction should include, as appropriate: - steps to correct noncompliance of a regulation, - measures to prevent reoccurrence of noncompliance, - person(s) responsible for implementing each step and/or monitoring any preventive measure(s), and - the date by which the noncompliance will be corrected. Be advised that the Violation Notice, including the Plan of Correction and this Summary page will be posted on the VDSS web page and available for review by the general public. Do not write any names or other confidential information into your plan of correction.

Violations:

Standard #:	22VAC40-151-740-E-1-b
Description:	Violation: Based upon review of the current resident?s, CR1?s, record and interview with staff, the physical examination did not include the vision exam. Findings: 1) The ?vision exam? element is blank on CR1?s physical examination document. 2) During the interview, staff, A1, reviewed CR1?s physical examination document and confirmed the Licensing Specialist?s findings. 3) A1 stated the following in regard to CR1?s vision exam ? ?The doctor who completed the physical examination on CR1 does not do eye exams. An eye exam was scheduled for 5/16/19 with Dr. X (?X? is being used in lieu of the doctor?s name), but had to cancel the exam due to CR1's GED appointment.?
Plan of Correction:	Alpha House understands the importance of complete intake physicals upon arrival of new residents. Efforts will be made to ensure residents receive complete eye checks along with or in addition to their physical as quickly as possible to ensure all medical/ physical needs are met in a timely fashion. Intake physical requirements will be reviewed with all staff during staff meeting by 6/30/2019.
Standard #:	22VAC40-151-770-C
Description:	Violation: Based on review of staff schedules and interview with staff, the facility failed to maintain a schedule where child care staff shall not be on duty more than 16 consecutive hours, except in an emergency. Findings: 1) The Licensing Specialist noticed staff,S3, worked two consecutive shifts and was on duty more than 16 consecutive hours as documented on the following schedules: a. 2/25/19 ? 3/3/19 ? Saturday and Sunday, 3:00 PM ? 10:00 PM (7 hours) and 10:00 PM ? 8:00 AM (10 hours) - totaling to 17 hours b. 3/11/19 ? 3/17/19 ? Saturday and Sunday, 3:00 PM ? 10:00 PM (7 hours) and 10:00 PM ? 8:00 AM (10 hours) - totaling to 17 hours c. 3/18/19 ? 3/24/19 ? Saturday and Sunday, 3:00 PM ? 10:00 PM (7 hours) and 10:00 PM ? 8:00 AM (10 hours) - totaling to 17 hours d. 4/1/19 ? 4/7/19 - Saturday and Sunday, 2:00 PM ? 10:00 PM (8 hours) and 10:00 PM ? 8:00 AM (10 hours) - totaling to 18 hours e. 5/6/19 ? 5/12/19 - Saturday and Sunday, 12:00 PM ? 10:00 PM (10 hours) and 10:00 PM ? 8:00 AM (10 hours) - totaling to 20 hours f. 5/20/19 ? 5/26/19 - Saturday and Sunday, 2:00 PM ? 10:00 PM (8 hours) and 10:00 PM ? 8:00 AM (10 hours) - totaling to 18 hours 2) The Licensing Specialist asked staff, A1, if there was an emergency that lead to S3 working more than 16 consecutive hours. a. A1 stated no. b. A1 stated S3 does not live in the local area and is only available to work on the weekends to accumulate work hours. 3) The Licensing Specialist asked A1 if time sheets should be reviewed to disprove S3 worked the above-mentioned dates and times. a. A1 stated no and confirmed that S3 worked on the days noted above. 4) During the interview, A1 agreed with the Licensing Specialist?s findings.
Plan of Correction:	The Director accepts and acknowledges the responsibility for scheduling of staff and understands the requirement that restricts staff to working no longer to 16 hrs. consecutively. Director has spoken to staff member S3 to advise her that her hours will be reduced not to exceed 16 consecutive hours.
Standard #:	22VAC40-151-960-B-1
Description:	Violation: Based upon review of the current resident?s, CR1?s, record and interview with staff, the facility failed to document the time on the serious incident report (SIR). Findings: 1) The Licensing Specialist reviewed an SIR in CR1?s record dated for 2/24/19. 2) The Licensing Specialist noticed the time is missing from this SIR. 3) During the interview, staff, A1, reviewed this SIR and confirmed the Licensing Specialist?s findings.
Plan of Correction:	All SIR?s will be reviewed by staff writing the SIR and staff faxing the SIR to ensure all required components are clearly documented on each SIR. SIR requirements will be reviewed at staff meeting by June 30, 2019.