VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Restin South
6347 Crowell Gap Road
Roanoke, VA 24014
(540) 774-9255

Current Inspector: Cynthia Jo Ball (540) 309-2968

Inspection Date: Feb. 3, 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 ACCOMODATIONS AND RELATED PROVISIONS 22VAC40-73 BUILDING AND GROUNDS 22VAC40-73 EMERGENCY PREPAREDNESS 32.1 Reported by persons other than physicians 63.2 General Provisions. 63.2 Protection of adults and reporting. 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. 22VAC40-80 COMPLAINT INVESTIGATION. 22VAC40-80 SANCTIONS.

Comments:

The LI for Restin South conducted an on-site renewal inspection at the facility on 02/03/2022 from 9:am until 1:00pm. A tour of the facility physical plant was conducted and the morning activity and mid day meal were observed. Resident and staff records as well as other forms of facility documentation were reviewed and interviews were conducted with residents and staff. Medication administration was reviewed. A exit interview was conducted on-site with the facility administrator to review violations and provide opportunities for additional information to be provided. If you have any questions please contact your LI at 540-309-2968.

Violations:

Standard #:	22VAC40-73-210-A
Description:	Based on a review of staff records, the facility failed to ensure that staff received all required training annually. EVIDENCE: 1. The record for staff person 3 has documentation that between 07/18/2020 to 07/18/2021, only 2 hours of training on topics related to residents' mental impairments was received. The facility has a population of adults with mental impairments residing in the facility in which at least four hours of training annually shall focus on topics related to residents' mental impairments.
Plan of Correction:	The Administrator will have this employee complete her required training and will ensure that all employees receive 4 hours of training in mental impairments annually.
Standard #:	22VAC40-73-250-D
Description:	Based on a review of staff records, the facility failed to ensure that staff submitted a risk assessment for tuberculosis annually. EVIDENCE: 1. The record for staff person 3 has documentation that the last risk assessment for tuberculosis was completed on 01/20/2021.
Plan of Correction:	The Administrator has had the employee to completed an annual risk assessment for tuberculosis and will monitor to ensure that all employees receive a risk assessment annually.
Standard #:	22VAC40-73-320-A
Description:	Based on a review of resident records, the facility to ensure that physical examinations were completed in entirety. EVIDENCE: 1. The physical examination dated 07/16/2021 in the record for resident 3 is incomplete as it lacks documentation of a statement that the individual does not have any of the conditions or prohibited care needs or a statement that specifies whether the individual is or is not capable of self-administering medication. 2. The physical examination dated 08/04/2021 in the record for resident 4 is incomplete as it lacks documentation of a statement that the individual does not have any of the conditions or prohibited care needs, a statement that specifies whether the individual is considered to be ambulatory or non-ambulatory or a statement that specifies whether the individual is or is not capable of self-administering medication.
Plan of Correction:	The Administrator has had the residents physicians complete their physical examinations to include all required information and will ensure that any new residents have complete physical examinations prior to their admission.
Standard #:	22VAC40-73-350-B
Description:	Based on a review of resident records, the facility failed to ascertain, prior to admission, whether a potential resident is a registered sex offender. EVIDENCE: 1. The record for resident 3, admitted on 07/27/2021, has documentation that a sex offender screen was not completed until 08/05/2021.
Plan of Correction:	The Administrator will ensure that a sex offender screening is completed prior to any residents admission.
Standard #:	22VAC40-73-440-A
Description:	Based on a review of resident records, the facility failed to ensure that uniform assessment instruments (UAIs) were completed as required. EVIDENCE: 1. The private pay UAI dated 12/01/2021 in the record for resident 3 is incomplete as it does not have any documentation for the residents level of orientation. 2. The public pay UAI dated 07/14/2021 in the record for resident 4 is incomplete as it does not have documentation of the residents need for medication administration, his level of orientation or his behavior pattern.
Plan of Correction:	The Administrator has had both residents UAI's corrected and will review all residents UAI's moving forward to ensure that they are completed as required.
Standard #:	22VAC40-73-450-F
Description:	Based on a review of resident records, the facility failed to ensure that individualized service plans (ISPs) were updated as changes in residents condition occurred. EVIDENCE: 1. The uniform assessment instrument (UAI) dated 12/16/2021 in the record for resident 2 has documentation that the resident is disoriented to some spheres all the time with time and place being the spheres affected. The ISP dated 01/31/2022 in the record for resident 2 does not address this identified need. 2. The UAI dated 12/01/2021 in the record for resident 3 has documentation that the resident is incontinent of bladder and wears pull ups. The record also has a physician order dated 07/30/2021 for the resident to be on a 1800 calorie ADA diet. The ISP dated 01/31/2022 in the record for resident 3 does not address these identified needs. 3. The UAI dated 07/14/2021 in the record for resident 4 has documentation that the resident required mechanical assistance with bathing and dressing. The ISP dated 01/31/2022 in the record for resident 4 does not address these identified needs.
Plan of Correction:	The Administrator has had all ISP's updated and review all resident ISP's to ensure that identified needs are addressed correctly.
Standard #:	22VAC40-73-490-D
Description:	Based on a review of the facility health care oversight, the facility failed to ensure that the date of the healthcare oversight was included. EVIDENCE: 1. The facility healthcare oversight report completed for the months of July 2021 through December 2021 does not include the date that the actual oversight was completed.
Plan of Correction:	The Administrator has reviewed the healthcare oversight requirements with the facility oversight nurse and will ensure that all future healthcare oversights are dated as required.
Standard #:	22VAC40-73-610-D
Description:	Based on a review of resident records, the facility failed to ensure that special diets prescribed by a physician were prepared and served according. EVIDENCE: 1. The record for resident 3 has documentation of a physician order dated 07/30/2021 for the resident to be on an 1800 calorie ADA diet. Per an interview with staff person 1 at the beginning of the inspection, there were no residents who were currently on a special diet..
Plan of Correction:	The Administrator has contacted the residents physician and the residents diet order has been changed to a regular diet. The Administrator will review resident records to ensure that diets are reviewed appropriately with their physician's.
Standard #:	22VAC40-73-700-2
Description:	Based on observations of the facility physical plant, the facility failed to ensure that a " No Smoking-Oxygen in Use" sign was posted in any room where oxygen is in use. EVIDENCE: 1. The middle room in the back hallway was noted to have an oxygen concentrator sitting by the second bed. The room did not have a "No Smoking-Oxygen in Use" sign posted on the day of inspection. 2. The room to the left in the hallway heading towards the dining room was noted to have an oxygen concentrator sitting by the second bed. The room did not have a "No Smoking-Oxygen in Use" sign posted on the day of inspection.
Plan of Correction:	The Administrator has posted "NO Smoking-Oxygen in Use" signs by both rooms were oxygen is in use.
Standard #:	22VAC40-73-870-A
Description:	Based on observations made of the facility physical plant, the facility failed to maintain the interior of the building. EVIDENCE: 1. The ceiling in the middle room on the back hallway was noted to have several areas of chipping/peeling paint.
Plan of Correction:	The Administrator has scheduled a painter to fix the ceiling on 02/16/2022.
Standard #:	22VAC40-73-950-A
Description:	Based on a review of the facility emergency preparedness and response plan, the facility failed to ensure that annual contact with the local emergency coordinator to determine, local disaster risks, communitywide plans to address different disasters and emergency situations, and assistance, if any, that the local emergency management office will provide to the facility in an emergency was made. EVIDENCE: 1. The facility emergency preparedness and response plan has documentation that the last contact with the facility local emergency coordinator was conducted on 01/06/2020.
Plan of Correction:	The Administrator has reached out to the local emergency coordinator to have the facility plan reviewed. The Administrator will ensure that this review occurs annually.