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: Feb. 5, 2024

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 22VAC40-80 The License

Technical Assistance:

Discussed cleanliness of the stove hood and the overall cleanliness of the stove oven. 470B. Discussed bench on outside patio required screws to be tighten. 530A.

Comments:

Type of inspection: Renewal Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 2/5/2024 from 10:30a.m. 6:30 p.m. and 2/6/2024 12:00 p.m. to 7:00 p.m. The Licensing Inspectors (Irvin Goode and Sherry Woodard) met with the Program Director to initiate the inspection on 2/5/2024 and 2/6/2024. Number of residents in care at the beginning of the inspection (3) The Licensing Inspectors completed a tour of the physical plant that included building and grounds of the facility. Number of resident?s records reviewed (3) Number of discharge records reviewed (2) Number of staff records reviewed: (1) Background checks only (4) Number of new staff records reviewed: (1). Number of interviews conducted with residents (2) Number of interviews conducted with staff (1) Observations by licensing inspector: posting of the license and inspection documents was observed. The following is a listing of the activities for this inspection: Reviewed one current resident record and two discharged resident records. Reviewed medication administration records. Two personnel records with one being a new staff member. One staff member and 2 residents were interviewed. An inspection of the interior and the exterior of the facility was completed. Other documentation included emergency fire drill documentation, menus, and staff work schedules, fire inspection and the health and safety inspections. The evidence gathered during the inspection determined (5) violations with applicable standard(s) or law. The inspection summary will be posted to the VDSS website within five (5) business days of your receipt of the inspection summary. 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. The licensee can 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, Irvin D. Goode, Licensing Inspector at 804-543-5188 or by email at Irvin.Goode@dss.virginia.gov

Violations:

Standard #:	22VAC40-151-240-B-8
Description:	Violation: - Based on record review, S1, the agency failed to obtain verification of staff?s educational requirements. Findings: 1. S1 date of Employment was 9/1/2023. 2. A review of S1's personnel record failed to document verification of education.
Plan of Correction:	22VAC40-151-(2)-240-B-8 Alpha House, prior to this violation, considered documentation on resumes and application of employment as educational level documentation accept in the case of administration staff who had to provide transcripts. Since this violation, all staff have been requested to produce copies of their educational diplomas including high school to satisfy the request of the licensing authority. All staff have been asked to provide their educational documentation as soon as possible.
Standard #:	22VAC40-151-240-B-8
Description:	Violation: - Based on record review, S2, the agency failed to obtain verification of staff?s educational requirements. Findings: 1. S2 date of Employment was 12/19/2023. 2. A review of S2 personnel record failed to document verification of education.
Plan of Correction:	Alpha House, prior to this violation, considered documentation on resumes and application of employment as educational level documentation accept in the case of administration staff who had to provide transcripts. Since this violation, all staff have been requested to produce copies of their educational diplomas including high school to satisfy the request of the licensing authority. All staff have been asked to provide their educational documentation as soon as possible
Standard #:	22VAC40-151-660-E
Description:	Violation: Based on record review, the agency failed to document and complete a quarterly review of resident progress 60 days following the initial service plan for CR (1) admitted on 10/3/23. 1. (CR-1) was admitted on 10/3/23. 2. Initial service plan for (CR-1) was developed and signed by staff on 10/4/23. 3. The record contained one quarterly review for (CR-1) which was not completed 60 days following the development of the initial service plan. 4. Quarterly review in record for (CR-1) was dated 1/3/24 and covered the period of 11/3/23-1/3/24. 5. The findings were discussed during the exit interview
Plan of Correction:	Alpha House has been incorrectly completing quarterly reports 60 days after the annual service plan date rather than the initial service plan date since 1998. With this violation, it was pointed out the first quarterly report should be done within 60 days on the initial service plan not the annual service plan. Alpha House shall immediately make this adjustment to be in compliance with standards by writing the first quarterly report for a resident on approximately the 60th day in placement.
Standard #:	22VAC40-151-740-E-1-f
Description:	Violation: Based on record review, the agency failed to complete all the required areas under the section titled ?general physical conditions? of the physical examination report. 1. (CR-1) was admitted on 10/3/23. 2. Nutritional requirement section on the physical examination report completed on 10/11/23 for (CR-1) was not addressed and left blank. 3. The findings were discussed during the exit interview.
Plan of Correction:	Director shall review during staff meeting on 2/20/24, with all the staff the importance of ensuring all questions on the resident physical form is completed by the physician during the medical visit and appropriately documented on the physical form
Standard #:	22VAC40-151-740-E-1-g
Description:	Violation: Based on record review, the agency failed to complete all the required areas under the section titled ?general physical conditions? of the physical examination report. 1. (CR-1) was admitted on 10/3/23. 2. Restrictions on physical activities section on the physical examination report completed 10/11/23 for (CR-1) was not addressed and left blank. 3. The findings were discussed during the exit interview.
Plan of Correction:	Director shall review during staff meeting on 2/20/24, with all the staff the importance of ensuring all questions on the resident physical form is completed by the physician during the medical visit and appropriately documented on the physical form
Standard #:	22VAC40-151-750-F-6
Description:	Violation: Based on record review, the agency failed to document on February 2024 medication administration record for CR-1 the identity of the individual who administered medication. 1. (CR-1) was admitted on 10/3/23. 2. Medication #1 listed on medication administration record for (CR-1) was not signed or initialed by individual who administered medication #1 scheduled at 7am on 2/5/24. 3. The findings were discussed during the exit interview.
Plan of Correction:	Director shall review with staff the importance of immediate. documentation of all administered medication at staff meeting on 2/20/24