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: Oct. 6, 2022 and Oct. 19, 2022

Complaint Related: No

Areas Reviewed:

22VAC40-151 Administration 22VAC40-151 Residential Environment 22VAC40-151 Programs and Services 22VAC40-151 Programs and Services 22VAC40-151 Disaster or Emergency Planning

Technical Assistance:

Discussed documentation of staff supervision as noted in CRF standard 22 VAC 40-151-260.3. Discussed security measures to protect records from loss, inadvertent or unauthorized access, and disclosure of information as noted in CRF standard 22 VAC 40-151-580.C.3. Discussed the application for admission as it pertains to physical health needs, including the immunization needs of the prospective resident as noted in CRF standard 22 VAC 40-151-620.B.3. Discussed the face sheet in the resident?s record as it pertains to race as noted in CRF standard 22 VAC 40-151-640.A. Distributed the Initial Objectives and Strategies as it pertains to it being distributed to affected staff and the resident as noted in CRF standard 22 VAC 40-151-650.

Comments:

Number of residents in care at the beginning of the inspection: 2 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident?s records reviewed: 2 Number of staff records reviewed: 3 Number of interviews conducted with residents: 1 Number of interviews conducted with staff: 2 Additional Comments/Discussion: An entrance meeting was held on 10/6/22. The Team Leader was accessible and available during the inspection. The following is a listing of the activities for this inspection: Reviewed one current resident record and one discharged resident record. Reviewed medication administration records. Three staff records were reviewed. No discrepancies were found with the CRF matrix. One staff member 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 Team Leader were interviewed during the preliminary findings meeting held at the facility on 10/12/22. The exit meeting was held on 10/19/22 to review the inspection findings. 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 Michele Freeman, Licensing Inspector at (804) 662-7062 or by email at michele.freeman@dss.virginia.gov

Violations:

Standard #:	22VAC40-151-740-A
Description:	Violation: Based upon the review of the current resident?s, CR1?s, record and interview with staff, the facility failed to ensure the child accepted for care had a physical examination by or under the direction of a licensed physician no earlier than 90 days prior to admission to the facility or no later than 7 days following admission. Findings: 1) Current resident, CR1, was admitted to this facility on 7/15/22. 2) A physical examination is in CR1?s record dated for 7/25/22, which exceeds 7 days following admission. 3) During the interview, staff, S4, acknowledged the findings as it pertains to the date on the physical form.
Plan of Correction:	Intake physical was scheduled as soon as possible, efforts to obtain an appointment with a physician that would take a new Medicaid patient within 7 days was not possible due to physician availability. An appointment was scheduled and the resident was seen on the 10th day following admission and received TB screening (negative) and intake physical on July 25, 2022. Director will continue to work with physicians and referring agencies to ensure intake physical will be completed within the 7 day required period.
Standard #:	22VAC40-151-740-B
Description:	Violation: Based on review of the current resident?s, CR1?s, record and interview with staff, the facility failed to ensure the resident had a screening assessment for tuberculosis (TB) within 7 days of placement. Findings: 1) Current resident, CR1, was admitted to this facility on 7/15/22. 2) A screening assessment for TB is in CR1?s record dated for 7/25/22, which exceeds 7 days within placement. 3) During the interview, staff, S4, acknowledged the findings as it pertains to the date on the screening assessment for TB.
Plan of Correction:	Intake physical was scheduled as soon as possible, efforts to obtain an appointment with a physician that would take a new Medicaid patient within 7 days was not possible due to physician availability. An appointment was scheduled and the resident was seen on the 10th day following admission and received TB screening (negative) and intake physical on July 25, 2022. Director will continue to work with physicians and referring agencies to ensure intake physical will be completed within the 7 day required period.