VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Seasoned Adult Day Care LLC
813 W. Nine Mile Road
Highland springs, VA 23075
(804) 651-9254

Current Inspector: Yvonne Randolph (804) 662-7454

Inspection Date: Aug. 29, 2023

Complaint Related: No

Areas Reviewed:

22VAC40-61 GENERAL PROVISIONS 22VAC40-61 ADMINISTRATION 22VAC40-61 PERSONNEL 22VAC40-61 SUPERVISION 22VAC40-61 ADMISSION, RETENTION AND DISCHARGE 22VAC40-61 PROGRAMS AND SERVICES 22VAC40-61 BUILDINGS AND GROUND

Comments:

Type of inspection: Monitoring Date of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 8/28/23 2p to 4p 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: 1 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of participant records reviewed: 2 Number of staff records reviewed: 2 Number of interviews conducted with participants: 0 Number of interviews conducted with staff: 1 Observations by licensing inspector: postings, activity, staff/participant interactions An exit meeting will be conducted 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 Yvonne Randolph, Licensing Inspector at (804) 662-7454 or by email at Yvonne.randolph@dss.virginia.gov

Violations:

Standard #:	22VAC40-61-50-E
Description:	Based on a review of two participant files, participants rights were not posted or reviewed with the participant and/or the participant?s legal representative or family member. Evidence: The rights were not observed as posted and were not found in the files of participant # 1 or # 2.
Plan of Correction:	Participant rights will be added to files.
Standard #:	22VAC40-61-180-D
Description:	Based on a review of two staff files, a background check and tuberculosis screening was not obtained for two staff. Evidence: A background check and tuberculosis screening/report was not found during a review of staff files # 1 and # 2.
Plan of Correction:	Background checks and tuberculosis screenings will be secured and added to files.
Standard #:	22VAC40-61-220-G
Description:	Based on a review of two participant files, the initial assessments were not signed and dated by staff. Evidence: The file reviews for participant # 1 and Participant # 2 found initial assessments that were not signed or dated by staff.
Plan of Correction:	Assessments will be signed and updated by designated staff.
Standard #:	22VAC40-61-230-A
Description:	Based on a review of two participant files, participant files did not include a plan of care that was signed and dated by staff and the participant and/or the legal representative of the participant, that was completed prior to or at admission and or that included required elements (expected date of outcome, activities/services provided to meet goal/need, how often services will be provided, who will provide services, the date goal/need was identified). Evidence: During the file reviews, the plans of care for participant # 1 and participant # 2 were found incomplete and not signed.
Plan of Correction:	Plan of care shall be completed and placed in files.
Standard #:	22VAC40-61-250-B
Description:	Based on a review of two participant files, participant files did not contain a current photo or narrative description. Based on a review of two participant files, participant files did not contain a current photo or narrative description. Evidence: A photo or narrative description was not found during the file reviews for participants # 1 and # 2.
Plan of Correction:	Photos shall be placed in files.
Standard #:	22VAC40-61-260-B
Description:	Based on a review of two participant files, a physical and tuberculosis screening was not completed within 90 days of admission for one participant. Evidence: A physical and tuberculosis screening was not found during the file review for participant # 2.
Plan of Correction:	Physical and TB screening shall be placed in files.
Standard #:	22VAC40-61-280-B
Description:	Based on a review of two participant files on 8/28/23, health care supervision is not provided Evidence: Health care supervision was not documented in the participant?s files.
Plan of Correction:	Health care supervision will be placed in files.
Standard #:	22VAC40-61-330-G-5
Description:	Based on an inspection of the center on 8/28/23, an activity schedule was not posted in a place readily available to participants and/or families. Evidence: A posted activity schedule was not observed.
Plan of Correction:	Activity schedule will be posted as required.
Standard #:	22VAC40-61-360-B
Description:	Based on an inspection of the center on 8/28/23, menus for meals and snacks for the current week were not posted in an conspicuous place for participants. Evidence: A posted menu of meals and snacks was not observed.
Plan of Correction:	Menus will be posted as required,
Standard #:	22VAC40-61-480-A
Description:	Based on an inspection at the center on 8/28/23, a separate area is not available for participants who become ill or need rest or privacy. Evidence: A separate area was not observed.
Plan of Correction:	An area has been designated.
Standard #:	22VAC40-61-540-E
Description:	Based on an inspection at the center on 8/23/23, there was no record of fire drills. Evidence: A record of fire drills was not provided.
Plan of Correction:	Fire drills will be completed as required and posted.