VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Skyline 21, LLC
3104 Camelot Blvd
Chesapeake, VA 23323
(757) 348-5510

Current Inspector: Margaret T Pittman (757) 641-0984

Inspection Date: June 7, 2023

Complaint Related: No

Areas Reviewed:

22VAC40-61 GENERAL PROVISIONS 22VAC40-61 ADMINISTRATION 22VAC40-61 SUPERVISION 22VAC40-61 PROGRAMS AND SERVICES 22VAC40-61 BUILDINGS AND GROUND 22VAC40-61 EMERGENCY PREPAREDNESS

Technical Assistance:

22VAC40-61-300 22VAC40-61-410

Comments:

Type of inspection: Initial Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 12:25 pm to 12:50 pm on 06/07/2023. The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. Number of participants present at the facility at the beginning of the inspection: 0 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Additional Comments/Discussion: LI and LA conducted initial inspection of the center. An exit meeting will be conducted to review the inspection findings. The evidence gathered during the initial inspection determined non-compliance with applicable standard(s) or law, and violation(s) were documented on the violation notice issued to the facility. The applicant has the opportunity to submit a plan of correction to indicate how the cited violation(s) will be addressed in order to maintain future compliance with applicable standard(s) or law. If the applicant 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 should the facility be issued a license to operate. 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 a licensed facility. For more information about the VDSS Licensing Programs, please visit: www.dss.virginia.gov Should you have any questions, please contact M. Tess Pittman, Licensing Inspector at (757) 641-0984 or by email at tess.pittman@dss.virginia.gov.

Violations:

Standard #:	22VAC40-61-50-B
Description:	Based on observation, the center failed to ensure the rights of participants are printed in at least 14-point type and posted conspicuously in a public place in the center. Evidence: 1. During an inspection of the center with Staff #1, the rights of participants were not posted in the center.
Plan of Correction:	Participant Rights and LA Christopher Robinson have been added and hung up on wall to facility.
Standard #:	22VAC40-61-50-D
Description:	Based on observation, the center failed to ensure the posting of the name and telephone number of the appropriate regional licensing administrator of the department; the Adult Protective Services toll-free telephone number; the toll-free telephone number of the Virginia Long-Term Care Ombudsman Program and any local ombudsman program servicing the area; and the toll-free telephone number of the disAbility Law Center of Virginia. Evidence: 1. During an inspection of the center with Staff #1, there was not a posting in the center that included the name and telephone number of the appropriate regional licensing administrator of the department; the toll-free telephone number of the Virginia Long-Term Care Ombudsman Program and any local ombudsman program servicing the area; and the toll-free telephone number of the disAbility Law Center of Virginia.
Plan of Correction:	Participant Rights and LA Christopher Robinson have been added and hung up on wall to facility.
Standard #:	22VAC40-61-330-G-5
Description:	Based on observation, the center failed to ensure the current month's schedule of activities is posted in a readily accessible location in the center. Evidence: 1. During an inspection of the center with Staff #1, the activity calendar was not posted in the center.
Plan of Correction:	All menus and Calendars have been posted to facility for display.
Standard #:	22VAC40-61-360-B
Description:	Based on observation and documentation, the center failed to ensure menus for meals and snacks for the current week are dated and posted in an area conspicuous to participants. Evidence: 1. During an inspection of the facility with Staff #1, the menu for meals for the current week was not posted in the center.
Plan of Correction:	All menus and Calendars have been posted to facility for display.
Standard #:	22VAC40-61-440-B-3
Description:	Based on observation, the center failed to ensure an area for supervised outdoor activities be equipped with appropriate seasonal outdoor furniture. Evidence: 1. During an inspection of the center with Staff #1, the area available and accessible for supervised outdoor activities was shown without any appropriate seasonal outdoor furniture.
Plan of Correction:	The outdoor bench has been purchased and placed in front of front door entrance outside.
Standard #:	22VAC40-61-460-H
Description:	Based on observation, the center failed to ensure hot water at taps available to participants are maintained within a temperature range of 105?F to 120?F. Evidence: 1. During an inspection of the center with Staff #1, the hot water temperature in one of the two bathrooms to be utilized by participants read 152?F.
Plan of Correction:	The hot water heater has been adjusted from 150 degrees to 110 degrees to ensure participant safety.
Standard #:	22VAC40-61-530-B
Description:	Based on observation, the center failed to ensure a fire and emergency evacuation drawing show primary and secondary escape routes, areas of refuge, assembly areas, telephones, fire alarm boxes, and fire extinguishers shall be posted in a conspicuous place. Evidence: 1. During an inspection of the center with Staff #1, the fire and emergency evacuation drawings did not include primary and secondary escape routes, areas of refuge, assembly areas, telephones, fire alarm boxes, and fire extinguishers.
Plan of Correction:	The emergency evacuation route and directions have been added to The Fire Emergency Exit informing the participants where they will meet in the parking lot in the case emergency or dangerous situation in the building.
Standard #:	22VAC40-61-550-A
Description:	Based on observation, the center failed to ensure each building of the center and all vehicles being used to transport participants shall contain a first aid kit which shall include a list of items as identified in the standard. Evidence: 1. During an inspection of the center with Staff #1, the first aid kit of the building was not available for review.
Plan of Correction:	As Per request we have added multiple first aids kits to facility including item that were not located in kit such as thermometer, sting kill. One first aid kit will be accessible at the front entrance at sign in table and another will be locked in medicine cabinet in director?s office.