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: Sept. 7, 2021 and Sept. 23, 2021

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 emergency admissions as it pertains to documentation of an oral request for care and justification of why the resident is to be admitted on an emergency basis as noted in standard 610.2. Discussed the face sheet as it pertains to the admission date as noted in standard 640.A.

Comments:

A monitoring inspection was initiated on 9/7/21 and concluded on 9/23/21. The Program Director was contacted by telephone to initiate the inspection. The Program Director reported that the current census was five (5) residents. The Licensing Specialist emailed the Program Director a list of items required to complete the remote documentation review portion of the inspection. The following is a listing of the activities for this inspection: Reviewed one current resident record. Reviewed health care and medication administration records. Two personnel records were reviewed. No discrepancies were found with the CRF matrix. The Program Director was interviewed on 9/17/21, 9/20/21, and 9/22/21. Other documentation reviewed during this inspection included, but was not limited to the following: emergency drill documentation, staff work schedules, and daily log book entries. An on-site inspection of the interior and exterior of the facility was conducted on 9/20/21. Upon receipt of this violation notice, a plan of correction is requested for the 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 Virginia Department of Social Services? 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-f
Description:	Violation: Based upon review of the current resident?s, CR1?s, record and interview with staff, the physical examination did not include all information necessary to determine the health and immunization needs of the resident, including nutritional requirements. Findings: 1) The ?nutrition? element is blank or incomplete on the physical examination form. 2) Staff, S3, agreed this element is blank or incomplete.
Plan of Correction:	Staff will be retrained on checking medical documents prior to leaving medical appointments with youth to avoid missing documentation. Overnight staff will serve as quality assurance to double check all document as a second set of eyes to review documents and ensure all required information is provided by the physicians. Training will be provide by the Director no later than September 30, 2021.