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: June 11, 2020 , June 15, 2020 , July 28, 2020 and Aug. 27, 2020

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 using the updated version of the ?Standards for Licensed Children?s Residential Facilities? manual that was hyperlinked to a notice emailed by the department to children?s residential facilities on 12/17/18. Discussed monitoring and evaluating service quality and effectiveness as noted in standard 120.D. Discussed training as it pertains to the Standards for Licensed Children?s Residential Facilities including the prohibited actions as noted in standard 250.A.3.d. Discussed menus as noted in standard 760.B.

Comments:

This inspection was conducted by licensing staff using an alternate remote protocol necessary due to a state of emergency health pandemic declared by the Governor of Virginia. A renewal inspection was initiated on 6/11/20 and concluded on 8/27/20. The Program Director was contacted by telephone to initiate the inspection. The Program Director reported the current census is one (1) resident. The inspector emailed the Program Director a list of items required to complete the inspection. The following is a listing of the activities for this inspection: The inspector reviewed one resident record and one medication administration record. Two personnel records, which includes one new staff member hired since the September 2019 monitoring inspection, were reviewed. No discrepancies were found with the CRF matrix. One staff was interviewed. Other documentation reviewed during this inspection included, but was not limited to the following: emergency drill documentation, menus, and staff work schedules. Lastly, the Licensing Specialist interviewed the Program Director on 7/28/20 in order to seek clarification about a few items submitted to complete the inspection. 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 #:	22VAC40-151-750-F
Description:	Violation: Based on review of the medication administration record (MAR) for current resident, CR1, the MAR was not maintained for all medicines received by the resident. Findings: 1) The MAR has a box for staff to initial for each day of the month that medication is given. 2) The Licensing Specialist observed the MAR box dated for 5/15/20 for M1 was empty. 3) Staff, S3, confirmed during the interview on 7/28/20 the MAR box dated for 5/15/20 for M1 was empty.
Plan of Correction:	Alpha House director will review with staff the importance of signing the MAR for all administered medication as it is passed to resident. Overnight staff will serve as quality assurance checking all medications nightly to ensure medication has been properly signed off as administered or Medication error forms have been completed for any missed/refused medication. This review will be completed with all staff by September 4, 2020.