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: Feb. 20, 2024

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 22VAC40-61 EMERGENCY PREPAREDNESS

Comments:

Type of inspection: Renewal Mandated Date of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 02/20/24 10 am to 12:20 p 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: 1 Number of staff records reviewed: 2 Number of interviews conducted with participants: 1 Number of interviews conducted with staff: 1 Observations by licensing inspector: required postings, activity, physical plant, infection control An exit meeting was 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 #:	22VAC40-61-110-A
Description:	Based on a review of staff files, one staff did not have orientation prior to working directly with participants. Evidence: There was no documentation of orientation in the file of staff # 1.
Plan of Correction:	Staff orientation to be completed. Licensee or designee will ensure completion of orientation prior to staff working with participants. Documentation of orientation to be placed in staff file
Standard #:	22VAC40-61-180-D
Description:	Based on a review of staff files, personal and social data to include an original criminal record check was not maintained for one staff . Evidence: Personal and social data and an original criminal background check was not found in the file of staff # 1.
Plan of Correction:	Licensee and/or designee will ensure that social and personal information and the original criminal record report is placed in staff file.
Standard #:	22VAC40-61-180-E-2
Description:	Based on a review of staff files, one staff was not screened annually for tuberculosis in a communicable form. Evidence: An annual tuberculosis screening was not documented in the file of staff #1.
Plan of Correction:	Licensee and/or designee will ensure that an annual tuberculosis screening is secured for staff.
Standard #:	22VAC40-61-220-E
Description:	Based on a review of a participant file, the assessment for one participant was not reviewed ad updated at least every six months. Evidence: The written assessment for participant # 1 was documented as completed on 7/24/23. The assessment has not been updated.
Plan of Correction:	Assessment to be updated. Licensee or designee will ensure that assessments are completed every 6 months or as needed.
Standard #:	22VAC40-61-230-F
Description:	Based on a review of a participant file, the plan of care was not signed and dated by the participant, family member or legal representative. Evidence: The plan of care for participant # 1 (dated 8/23/23) only contained the signature of staff.
Plan of Correction:	Licensee or designee will ensure that plan of care is signed by participant or responsible party.