VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Premier Residential and Assisted Living
904 George Washington Hwy North
Chesapeake, VA 23323
(757) 410-2754

Current Inspector: Donesia Peoples (757) 353-0430

Inspection Date: May 1, 2023

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 BUILDINGS AND GROUND 22VAC40-73 EMERGENCY PREPAREDNESS 63.2 LICENSURE AND REGISTRATION PROCEDURES 63.2 FACILITIES AND PROGRAMS 22VAC40-90 BACKGROUND CHECKS FOR ASSISTED LIVING FACILITIES 22VAC40-90 THE SWORN STATEMENT OR AFFIRMATION 22VAC40-90 THE CRIMINAL HISTORY RECORD REPORT 22VAC40-80 THE LICENSE 22VAC40-80 THE LICENSING PROCESS

Comments:

Type of inspection: Initial Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: An announced initial inspection took place on 05/01/23 at 8:15 am until 10:45 am. 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: 0 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 0 Number of staff records reviewed: 1 Number of interviews conducted with residents:0 Number of interviews conducted with staff: 1 Observations by licensing inspector: An observation of bedrooms, restrooms, dining area, common areas, and the kitchen were observed.The water temperatures were measured and the call signaling system was monitored. Additional Comments/Discussion: Measurements was completed in bedrooms that will be used for residents. An exit meeting will be conducted to review the inspection findings. The evidence gathered during the initial inspection determined non-compliance with applicable standard(s) or law, and violation(s) were documented on the violation notice issued to the facility. The applicant has the opportunity to submit a plan of correction to indicate how the cited violation(s) will be addressed in order to maintain future compliance with applicable standard(s) or law. If the applicant 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 should the facility be issued a license to operate. 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 a licensed facility. For more information about the VDSS Licensing Programs, please visit: www.dss.virginia.gov Should you have any questions, please contact Donesia Peoples, Licensing Inspector at 757-353-0430 or by email at donesia.peoples@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-860-G
Description:	Based on observation the facility failed to ensure the hot water at taps available to residents shall be maintained within a range of 105?F to 120?F. Evidence: 1. During the onsite inspection, the water temperature in two of the shared bathrooms that will be available to residents was measured 67.6, and 67.8-degrees F.
Plan of Correction:	The exit plan was copied based on city approved plan, and recommended changes made with key code highlighting the emergency areas, gathering points, and fire equipment items with color-coded markings
Standard #:	22VAC40-73-960-B
Description:	Based on observation the facility failed to ensure a fire and emergency evacuation drawing shall show primary and secondary escape routes, areas of refuge, assembly areas, telephones, fire alarm boxes, and fire extinguishers. Evidence: 1. During a tour of the facility with staff #1 the fire and emergency evacuation drawing posted in the facility did not show primary and secondary escape routes, areas of refuge, assembly areas, telephones, fire alarm boxes, and fire extinguishers.
Plan of Correction:	For the water temperature: our maintenance crew inspected the water heater. No issues were discovered as the water heater is set at the recommended temperature of 120 degrees, and the water temperature is heating at the recommended level. However, we have a pending appointment on 5/5/2023 with Philbrick Plumbing to service the water heater and second look at the sink
Standard #:	22VAC40-73-980-A
Description:	Based on observation the facility failed to ensure the first aid kit shall include blankets, disposable sing-use breathing barriers or shield, cold pack, plastic bags, small flashlight and extra batteries, and a thermometer. Evidence: 1. During observation and review of the first aid kit with staff #1, the following items were not located in the first aid kit: blankets, disposable single-use breathing barriers or shield, cold pack, plastic bags, small flashlight and extra batteries, and a thermometer.
Plan of Correction:	First Aid Kits are on order via Amazon with pending delivery of 05 May 2023.