VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Karolwood Gardens at Norfolk
6403 Granby Street
Norfolk, VA 23505
(757) 451-2400

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

Inspection Date: Dec. 19, 2022

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES 22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-73 RESIDENT ACCOMMODATIONS AND RELATED PROVISIONS 22VAC40-73 EMERGENCY PREPAREDNESS

Technical Assistance:

22VAC40-73-990

Comments:

Type of inspection: Complaint Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 12/19/2022 from 1:20 pm to 3:00 pm. The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. A complaint was received by VDSS Division of Licensing on 11/28/2022 regarding allegations in the area(s) of: Administration and Administrative Services, Resident Care and Related Services, Resident Accommodations and Related Provisions, and Emergency Preparedness. Number of residents present at the facility at the beginning of the inspection: 42 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of staff records reviewed: 3 Number of interviews conducted with staff: 2 An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation supported some, but not all of the allegation(s); area(s) of non-compliance with standard(s) or law were: Emergency Preparedness. A violation notice was issued; any violation(s) not related to the complaint but identified during the course of the investigation can also be found on the violation notice. 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 M. Tess Pittman, Licensing Inspector at (757) 641-0984 or by email at tess.pittman@dss.virginia.gov.

Violations:

Standard #:	22VAC40-73-950-E
Complaint related:	Yes
Description:	Based on interview, the facility failed to develop and implement a semi-annual review on the emergency preparedness and response plan for residents with emphasis placed on an individual's respective responsibilities. Evidence: 1. Staff #1 could not provide documentation that residents receive a semi-annual review on the emergency preparedness and response plan.
Plan of Correction:	A semi-annual review was implemented on emergency preparedness and response plan for residents with emphasis placed on an individual's respective responsibilities. Staff will be inserviced on 22VAC40-73. A town hall meeting will be held for residents to review emergency preparedness and response plan. The Administrator will monitor 22VAC40-73 for continued compliance.
Standard #:	22VAC40-73-970-E
Complaint related:	Yes
Description:	Based on record review and interview, the facility failed to ensure a record of the required fire and emergency evacuation drills be kept and include the items identified in the standard. Evidence: 1. For the month of November 2022, Staff #2 could only provide a sign in sheet for the staff that participated in the fire/evacuation drill. The document did not include the following: identity of the person conducting the drill, the date and time of the drill, the method used for notification of the drill, the number of residents participating, any special conditions simulated, the time it took to complete the drill, weather conditions, and problems encountered, if any.
Plan of Correction:	The November 2022 Fire Drill sheet was filled out entirely. The maintenance director was in-serviced on ensuring a record of the required fire and emergency evacuation drills be kept and include the items identified in the standard. A 100% audit was completed to ensure record compliance. Administrator will monitor monthly fire drill forms for compliance.