VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Memory Care at Bristol
301 Village Circle
Bristol, VA 24201
(276) 477-5334

Current Inspector: Rebecca Berry (276) 608-3514

Inspection Date: Aug. 4, 2022

Complaint Related: No

Areas Reviewed:

22VAC40-73 GENERAL PROVISIONS 22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES 22VAC40-73 PERSONNEL 22VAC40-73 STAFFING AND SUPERVISION 22VAC40-73 ADMISSION, RETENTION AND DISCHARGE OF RESIDENTS 22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-73 RESIDENT ACCOMMODATIONS AND RELATED PROVISIONS 22VAC40-73 BUILDINGS AND GROUND 22VAC40-73 EMERGENCY PREPAREDNESS 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS

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: 08/04/2022 2:20pm-5:01pm The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. 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: 08/04/2022 2:20pm-5:01pm The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. 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 Crystal B. Mullins, Licensing Inspector at 276-608-1067 or by email at crystal.b.mullins@dss.virginia.gov Violation Notice Issued: Yes A copy of this document will be sent to the licensee/provider for signature.

Violations:

Standard #:	22VAC40-73-660-A
Description:	Based on observations made during the tour of the building, the facility failed to properly store medications which are administered by the facility. EVIDENCE: 1. Resident # 3 had a 7 ounce bottle of Anti Dandruff Shampoo 1% with a pharmacy label stating it was to be used topically every Tuesday and Friday on shower days. This bottle was found in Resident #3?s shower on the date of the inspection.
Plan of Correction:	1.Antidandruff shampoo was removed from Resident #3's room on 08/04/22. 2. Staff and resident responsible parties will be educated on proper storage of medication/prescriptions. 3.Audit to be completed by the Director of the unit 3x/week for 2 weeks, then 1x/week for 2 weeks, and then monthly for 2 months. [sic]
Standard #:	22VAC40-73-860-I
Description:	Based on observations made during the tour of the building, the facility failed to store all hazardous materials in a locked area. EVIDENCE: 1. Resident #4 was observed to have a 11.8 ounce delicate petals body lotion on her dresser; a 15 ounce bottle of V05 extra body with collagen hair conditioner and a 7.5 ounce Derma Vena Skin and Hair Cleanser in her shower. The hair cleanser had a label on the back that stated, ?Keep out of reach of children?. There was a 21 ounce Jergens Ultra Healing Extra Dry Skin Moisturizer, a .85 ounce container of anticavity toothpaste that had a label stating, ?Keep out of reach of children under six?, a 4 ounce Colgate Anticavity Fluoride Toothpaste with a label stating, ?Keep out of reach of children under six years of age. If more than used for brushing is accidently swallowed get medical help or contact a poison control center right away? all located on the bathroom sink area.
Plan of Correction:	1. Hazardous materials were removed from resident #4's room on 8/4/22. 2. Staff and Resident responsible parties will be educated on proper storage of hazardous materials. 3. Audit to be completed by Director of the unit 3x/week for 3 weeks, then 1x/week for 2 weeks, and monthly for 2 months. [sic]