VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Linden House
1250 Branchlands Drive
Charlottesville, VA 22901
(434) 973-0311

Current Inspector: Angela Rodgers-Reaves (804) 662-9774

Inspection Date: Nov. 3, 2022

Complaint Related: No

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: 11/03/2022 10:14-1:43p.m. The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. Number of residents present at the facility at the beginning of the inspection: 77 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 10 Number of staff records reviewed: 6 Number of interviews conducted with residents:3 Number of interviews conducted with staff: 3 Observations by licensing inspector: Medication administration pass observed Additional Comments/Discussion: 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 Angela Rodgers-Reaves, Licensing Inspector at (804) 840-0253 or by email at angela.r.reaves@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-250-C
Description:	Upon request the facility did not submit for the inspector?s review documented evidence that sworn disclosure statements were obtained for the facility staff #s 1, 4 and 5.
Plan of Correction:	FACILITY'S RESPONSE: "Human Resource Manager was given a copy of the correct sworn disclosure statement form on the date of inspection, 11/3/2022 and it has been incorporated in the new hire packet. Current employee files will be audited and a correct sworn disclosure will be completed by November 30, 2022, by every employee whose existing form is incorrect. "
Standard #:	22VAC40-73-250-D
Description:	Based on the review of facility records with the facility Administrator the facility failed to ensure each staff member was evaluated annually and submitted the results of a risk assessment, documenting that the individual is free of tuberculosis in a communicable form as evidenced by the completion of the current screening form published by the Virginia Department of Health or a form consistent with it. Evidence: Staff #3: Documented date of hire 09/22/2020 The facility did not submit upon request for the inspector?s review documented evidence that an annual TB risk assessment was obtained for staff #3.
Plan of Correction:	FACILITY'S RESPONSE: "All employees will be evaluated and a TB risk assessment completed by November 30, 2022. All employees will be re-evaluated annually thereafter and a TB risk assessment will be completed and placed in their files."
Standard #:	22VAC40-73-320-B
Description:	Based on the review of facility records with the facility Administrator the facility failed to ensure that a risk assessment for tuberculosis was completed annually on each resident as evidenced by the completion of the current screening form published by the Virginia Department of Health or a form consistent with it. Evidence: Resident #1: Documented date of admission 04/22/2021 Resident #2: Documented date of admission 11/13/2019 Resident #3: Documented date of admission 10/15/2018 Resident # 7: Documented date of admission 09/20/2020 The facility did not submit upon request for the inspector?s review documented evidence that annual TB risk assessments were conducted on the residents.
Plan of Correction:	All residents will be evaluated for tuberculosis by November 30, 2022, and a risk assessment will be completed. All residents will be re-evaluated annually thereafter and a TB risk assessment will be completed and placed in their files."
Standard #:	22VAC40-73-550-G
Description:	Based on the review of facility records with the facility Administrator the facility failed to ensure that the rights and responsibilities of residents in assisted living facilities were reviewed annually with each resident or his legal representative or responsible individual. Evidence: Resident #1: Documented date of admission 04/22/2021 Resident #2: Documented date of admission 11/13/2019 Resident #3: Documented date of admission 10/15/2018 Resident # 7: Documented date of admission 09/20/2020. The facility did not submit upon request for the inspector?s review documented evidence that annual review of resident rights were conducted with the residents.
Plan of Correction:	FACILITY'S RESPONSE: "The Activity Coordinator and Memory Care Program Coordinator have begun reviewing the rights and responsibilities of residents with residents or their legal representatives or responsible individuals. This will be completed by November 30, 2022. Residents rights will be reviewed annually thereafter in November."