VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Alpha House I
4526 Brickwood Meadow Ct.
Petersburg, VA 23803
(804) 861-0596

Current Inspector: Irvin Goode (804) 543-5188

Inspection Date: Dec. 4, 2019 and Dec. 5, 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 22VAC40-151 SPECIAL PROGAMS

Technical Assistance:

Discussed the resident?s copy of the initial objectives and strategies as noted in standard 650. Discussed serious incident reports as it pertains to the name of the person to whom the report was made as noted in standard 960.B.5.

Comments:

An unannounced monitoring inspection was completed by the Licensing Specialist on 12/4/19 from 10:20 a.m. to 5:26 p.m. and 12/5/19 from 9:15 a.m. to 3:11 p.m. The current census is three (3) residents, which includes one infant. The following is a listing of the activities for this inspection: Reviewed two resident records. No residents have discharged from the facility since the June 2019 monitoring inspection; therefore there were no discharge records to review. Reviewed two medication administration records. Two personnel records, which includes two new staff members hired since the June 2019 monitoring inspection, were reviewed. No discrepancies were found with the CRF matrix. One staff and one resident 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 and the Residential Relief Counselor (on 12/5/19) were available and accessible during the inspection. An Exit Interview to review preliminary findings was conducted with the Program Director at approximately 12:25 p.m. on 12/5/19. The Acknowledgement of Inspection form was signed and left at the facility.

Violations:

Standard #:	22VAC40-151-190-B-1
Description:	Violation: Based on review of the personnel record, the facility failed to obtain the results of a screening assessment for tuberculosis (TB) at the time of hire. Findings: 1) The personnel record maintained by the facility for staff, S1, contained TB screening results dated eight days after the date of hire; results late. 2) S3 confirmed the test results were late and not completed at the time of hire.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-151-640-C
Description:	Violation: Based on review of the current resident?s, CR1?s, record and interviews with staff, the facility failed to maintain the face sheet for pregnant teens that shall also include the expected date of delivery and the name of the hospital to provide delivery services to the resident. Findings: 1) The Licensing Specialist reviewed CR1?s face sheet and noticed the ?delivery hospital? section was blank on the form. 2) S3 admitted to not completing this particular section of the face sheet. 3) S3 added the name of the hospital in front of the Licensing Specialist. a. The Licensing Specialist asked S3 to include her initials and the current date by the name of the hospital.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-151-730-B-4
Description:	Violation: Based on review of the information readily accessible to staff for CR1 and interview with staff, the facility failed to include the following element in the event of an emergency. Findings: 1) 730.B.4.c ? Information concerning substance abuse and use. a. The Licensing Specialist noticed this section of the form was blank or incomplete. 2) S3 agreed this section of the form is blank or incomplete.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-151-740-E-1-g
Description:	Violation: Based on review of CR1?s record and interview with staff, the physical examination report did not include restrictions on physical activities. Findings: 1) The areas indicating ?no? or ?yes? on the physical examination form as it pertains to restrictions on physical activities were left unchecked by the physician. 2) S3 agreed this section was incomplete.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-151-750-E
Description:	Violation: Based on review of the current residents?, CR1?s and CR3?s, medication administration records and interview with staff, the facility failed to demonstrate medication was administered as prescribed. Findings: 1) The medication administration record (MAR) has a box for staff to initial for each day of the month that medication is given. 2) The MARs for CR1 shows empty boxes on the following dates: a. August 2019 ? Medication, M1, on 8/21/19. b. October 2019 ? M1 on 10/31/19. 3) The MARs for CR3 shows empty boxes on the following dates: a. November 2019 ? M2 on 11/25/19, 11/26/19 and 11/27/19. b. November 2019 ? M3 on 11/26/19 and 11/27/19. 4) S3 reviewed the MARs, confirmed the boxes were empty, and agreed with the Licensing Specialist?s findings.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-151-1010-I
Description:	Violation: Based upon observation, review of the current resident?s, CR2?s, record and interviews with staff, the facility failed to maintain the record of each child 18 months or younger that includes the child?s feeding schedule and directions for feeding. This information shall be posted in the kitchen. Findings: 1) During the facility tour, the Licensing Specialist did not see CR2?s feeding schedule posted in the kitchen. 2) While reviewing CR2?s record, the Licensing Specialist did not see the feeding schedule. 3) During the exit interview, S3 was asked about the feeding schedule. S3 admitted to not developing a feeding schedule.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-151-1010-P
Description:	Violation: Based upon review of the current resident?s, CR2?s, record and interviews with staff, the facility failed to maintain the daily activity log for each child of the adolescent mother showing what activities the child actually participated in during the day. Findings: 1) The Licensing Specialist discovered the facility was not completing the daily activity logs for CR2 on a daily basis. a. CR2 was admitted to the facility on 11/7/19, daily activity logs were completed on the following days: 11/7/19 ? 11/21/19, 11/25/19, and 11/26/19. 2) During the exit interview, S3 was asked about the daily activity log. S3 mentioned these logs were not done on a daily basis because CR1, CR2?s mother, refuses to complete it. 3) S3 also mentioned staff assists the residents with completing these logs; however, the facility teaches the resident to complete it.
Plan of Correction:	Not available online. Contact Inspector for more information.