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Riverside Assisted Living at Smithfield
101 John Rolfe Drive
Smithfield, VA 23430
(757) 357-3282

Current Inspector: Donesia Peoples (757) 353-0430

Inspection Date: July 21, 2023

Complaint Related: Yes

Areas Reviewed:
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 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS
22VAC40-80 COMPLAINT INVESTIGATION

Comments:
ype of inspection: Complaint
Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: An unannounced monitoring inspection took place on 07/21/2023 from 8:56 am to 12:55 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 07/10/2023 regarding allegations in the area of: Admission, Retention, and Discharge of Residents and Resident Care and Related Services

Number of residents present at the facility at the beginning of the inspection: 51
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: 0
Number of interviews conducted with residents: 0
Number of interviews conducted with staff: 3
Observations by licensing inspector: An observation of the safe, secure unit was completed.

Additional Comments/Discussion: None

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: Admission, Retention, and Discharge of Residents and Resident Care and Related Services

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 Donesia Peoples, Licensing Inspector at 757-353-0430 or by email at donesia.peoples@dss.virginia.gov

Violations:
Standard #: 22VAC40-73-430-H-1
Complaint related: Yes
Description: Based on the record review and staff interview the facility failed to ensure at the time of discharge, the assisted living facility shall provide to the resident, and as appropriate, his legal representative and designated contact person a dated statement signed by the licensee or administrators the following information as listed in the section.

Evidence:
1. The record for resident #1, discharge statement dated 06/05/23 did not include a date the discharge statement was provided to the resident and the resident?s designated contact person.
Staff #1 confirmed the discharge statement was not provided to the resident and the resident?s designated contact person.
2. The record for resident #2, discharge statement dated 06/22/23, included documentation the resident, legal representative, and designated contact person was provided the discharge statement on 06/22/23, however staff #1 confirmed the discharge statement was not provided `to the resident, legal representative, and designated contact person.

Plan of Correction: Not available online. Contact Inspector for more information.

Standard #: 22VAC40-73-440-L
Complaint related: Yes
Description: Based on the record interview and staff interview the facility failed to maintain the completed Uniform Assessment Instrument (UAI) in the resident?s record.

Evidence:
1. During an interview with staff #1, staff #1 confirmed to have completed a UAI for resident #2 on 06/19/23. The record for resident #2 did not contain a UAI dated 06/19/23.

Plan of Correction: Not available online. Contact Inspector for more information.

Standard #: 22VAC40-73-450-E
Complaint related: No
Description: Based on the record review the facility failed to ensure the individualized service plan (ISP) shall be signed and dated by the licensee, administrator, or his designee, and by the resident or his legal guardian.

Evidence:
1. Resident #1?s ISP dated 06/19/23 was not signed by the facility and the resident or the legal guardian.
2. Resident #2?s ISP dated 03/03/22 was not signed by the facility and the resident or the legal guardian.
3. Resident #3?s ISP dated 02/20/23 was not signed by the facility and the resident or the legal guardian.
4. Resident #4?s ISP dated 03/01/23 was not signed by the facility and the resident or the legal guardian.
5. Resident #5?s ISP dated 04/22/23 was not signed by the facility and the resident or the legal guardian.

Plan of Correction: Not available online. Contact Inspector for more information.

Standard #: 22VAC40-73-450-F
Complaint related: No
Description: Based on the record review the facility failed to ensure the ISP shall be reviewed and updated at least once every 12 months.

Evidence:
1. The record for resident #2 contains an ISP dated 03/03/22. There is no documentation in the record of an ISP completed after 03/22/22.

Plan of Correction: Not available online. Contact Inspector for more information.

Disclaimer:
This information is provided by the Virginia Department of Social Services, which neither endorses any facility nor guarantees that the information is complete. It should not be used as the sole source in evaluating and/or selecting a facility.

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