VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Rosewood Village Hollymead Assisted Living, LLC
2029 Lockwood Drive
Charlottesville, VA 22911
(434) 963-7673

Current Inspector: Tamara Watkins (804) 662-7422

Inspection Date: April 4, 2023

Complaint Related: No

Areas Reviewed:

22VAC40-73 RESIDENT CARE AND RELATED SERVICES

Comments:

Type of inspection: Monitoring Date(s) of inspection 4/4/2023 The Acknowledgement of Inspection form was signed for each date of the inspection. A self-reported incident was received by VDSS Division of Licensing on 3/22/2023 regarding allegations in the area of Resident Care and Related Services. Number of residents present at the facility at the beginning of the inspection: 72 Number of resident records reviewed: 1 Number of interviews conducted with staff: 2 Additional Comments/Discussion: The evidence gathered during the investigation supported the self-report of non-compliance with standard(s) or law, and violation(s) were issued. 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 Tamara Watkins, Licensing Inspector at (804) 662-7422 or by email at tamara.g.watkins@dss.virginia.gov Violation Notice Issued: Yes

Violations:

Standard #:	22VAC40-73-460-A
Description:	Based on a review of a self-reported incident the facility failed to assume general responsibility for the health, safety, and well-being of a resident in their care. Evidence: In route to a doctor?s appointment in the community bus, the wheelchair of resident #1 tipped backward and the resident fell to the floor of the bus. The resident sustained a laceration on the back of her head and complained of back pain. The driver immediately stopped the bus and called 911 for assistance. The resident was transported to the hospital for evaluation. The driver did not correctly secure the front safety claws to the wheelchair. The resident returned from the hospital the same day of the incident with no serious injuries. She did have a cut on the back of her head that did not require stiches or staples
Plan of Correction:	Re-education on van safety was given to all employees that drive the bus. 3/23/2023