VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Shenandoah Senior Living
103 Lee Burke Road
Front royal, VA 22630
(540) 635-7923

Current Inspector: Sarah Pearson (540) 680-9469

Inspection Date: Jan. 26, 2024

Complaint Related: Yes

Areas Reviewed:

Staffing and Supervision

Comments:

A complaint was received by VDSS Division of Licensing on 1/19/2024 regarding allegations in the areas of staffing and supervision and resident care and related services. The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 5 Number of staff records reviewed: 2 Number of interviews conducted with residents: 0 Number of interviews conducted with staff: 3 Observations by licensing inspector: Additional Comments/Discussion: An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation did not support the allegations of non-compliance with standard(s) or law. However, violation(s) not related to the complaint 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 Sarah Pearson, Licensing Inspector at (540) 680-9469 or by email at sarah.pearson@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-40-A
Complaint related:	No
Description:	Based upon interviews and review of records, the facility failed to ensure compliance with their own policies and procedures regarding private duty personnel who are not employees of a licensed home care organization. Evidence: 1. Interview with collateral contact 1 conducted on 2/7/2024 revealed that Resident 1 had a paid caregiver providing direct care services twice a week at the facility. Collateral Contact 1 reported that the facility had been informed of the caregiver and initially the facility had indicated that the caregiver would need to complete paperwork, but the paperwork was never provided to the caregiver for completion. 2. The facility could not provide written information about the type and frequency of services to be delivered by the private caregiver for Resident 1. 3. The facility could not produce an original criminal history record check from the Virginia State Police for the private caregiver.
Plan of Correction:	At the time of admission of resident 1, POA/spouse misinformed the community representative, POA/spouse of resident 1 stated that the resident would have company for the time being, company as a family friend would be at the community 1 X week to ensure that resident 1 had adapted to the move adequately. Per resident 1 POA/spouse; the family friend was going to come to the community twice a week to visit with resident 1, it was later discovered that, in conversation, with resident 1 POA/spouse that the family friend was a private-duty sitter. Executive Director (ED), Resident Care Director (RCD) and Business Office Manager (BOM) and/or appropriate designee will ensure when a private duty personnel from a licensed home care organization provides direct care or companions services to residents in an assisted living facility. Will ensure that before any direct care personnel or companion services are initiated, the facility will obtain, in writing, information on the type and frequency of the services to be delivered to the resident by private duty personnel. ED, RCD, BOM and/or appropriate designee will review he information to determine if acceptable and provide notification to the home care organization regarding any needed changes. ED, RCD and/or BOM and/or appropriate designee will ensure that the direct care or companion service provided by private duty personnel to meet identified needs will be reflected on the resident individualized service plan. ED, RCD, BOM and/or appropriate designee will ensure that requirements regarding tuberculosis are applied to private duty personnel and that the required reports are maintained by the facility or the licensed home care organization. ED, RCD, and/or BOM will ensure that private duty personnel or companion services receive orientation and training regarding facilities policies and procedures or companion services receive orientation and training regarding facilities policies and procedure related to the duties of private duty personnel. ED, RCD and/or BOM will ensure that a criminal history report is issued by the Virginia Department of State Police have been issued a the time of obtained, written information regarding private duty personnel; but no later than 90 das prior to the date of initiation of services. Resident 1 has been discharged from the community effective as of: 01/25/2024