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: Aug. 1, 2023

Complaint Related: No

Areas Reviewed:

22VAC40-73 ADMISSION, RETENTION AND DISCHARGE OF RESIDENTS 22VAC40-73 RESIDENT CARE AND RELATED SERVICES

Comments:

Type of inspection: Monitoring Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 08/01/2023. The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. A self-reported incident was received by VDSS Division of Licensing on 06/19/2023 regarding allegations in the area(s) of: Admission, Retention and Discharge of Residents. Number of residents present at the facility at the beginning of the inspection: 39 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 1 Number of interviews conducted with residents:1 Number of interviews conducted with staff: 1 An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation did not support the self-report of non-compliance with standard(s) or law. However, violation(s) not related to the self-report but identified during the course of the investigation can 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 #:	22VAC40-73-310-D
Description:	Based on record review, the facility failed to provide written assurance to a resident or the legal representative documenting that the facility has the appropriate license to meet their care needs at the time of admission. Copies of the written assurance shall be given to the legal representative and case manager, if any, and a copy signed by the resident or his legal representative shall be kept in the resident's record. Evidence: 1. During the onsite inspection, the written assurance for Resident #1 (admitted 6/13/2023) was signed on 6/14/2023 and indicated ?Province Place of DePaul has the appropriate license? to meet the needs of Resident #1 at the time of admission.
Plan of Correction:	1. Resident #1's written assurance will be corrected to reflect Karolwood Gardens at Norfolk. 2. A 100% audit will be completed on all current residents' written assurance to ensure compliance. 3. Administrator or designee will review new resident paperwork to ensure compliance. 4. Current Admission paperwork will be reviewed in QAPI. Any trends will be reviewed and a POC will be completed as indicated.
Standard #:	22VAC40-73-430-D
Description:	Based on record review and interview, the facility has failed to assist the resident and their legal representative, if any, in the discharge or transfer process. The facility shall help the resident prepare for relocation, including discussing the resident's destination. Evidence: 1. There was no documentation within Resident #1?s record that the facility has assisted in the discharge or transfer process. 2. During an interview with Resident #1, Resident #1 indicated the facility has not provided alternative living arrangements or assistance in preparing for relocation. Collateral Contact #1 also indicated the facility has not provided alternative living arrangements or assistance in preparing for relocation.
Plan of Correction:	1. Resident #1 was assisted with discharge planning as indicated on the Discharge Notification and Statement VDSS Model Form-ALF. 2. Administrator and RCC met with resident on several occasions regarding discharge planning prior to inspection. 3. Administrator or designee will meet with resident and continue discharge planning. 4. Administrator/Designee will monitor discharge planning to ensure compliance.
Standard #:	22VAC40-73-450-A
Description:	Based on record review and interview, the facility failed to ensure on or within seven days prior to the day of admission, a preliminary plan of care be developed to address the basic needs of the resident that adequately protects their health, safety, and welfare. Evidence: 1. Resident #1 admitted to the facility on 06/13/2023; however, there was no preliminary plan of care on or within seven days prior to the day of admission in Resident #1?s record. 2. Staff #1 acknowledged the facility was unable to provide the preliminary plan of care for Resident #1.
Plan of Correction:	1. Resident #1's plan of care was completed. 2. An in-service will be completed with Department Head's regarding 22VAC40-73-450-A. 3. Administrator/Designee will review current residents' ISPs to ensure compliance. 4. Results from the review of ISPs will be reviewed in QAPI. Any trends will be discussed and POC completed as indicated.
Standard #:	22VAC40-73-450-C
Description:	Based on record review and interview, the facility failed to ensure the comprehensive individualized service plan be completed within 30 days after admission. Evidence: 1. Resident #1 admitted to the facility on 06/13/2023; however, there was not a comprehensive individualized service plan within Resident #1?s record. 2. Staff #1 acknowledged the facility was unable to provide the comprehensive individualized service plan for Resident #1.
Plan of Correction:	1. Resident #1's plan of care was completed. 2. An in-service will be completed with Department Head's regarding 22VAC40-73-450-C. 3. Administrator/Designee will review current residents' ISPs to ensure compliance. 4. Results from the review of ISPs will be reviewed in QAPI. Any trends will be discussed and POC completed as indicated.