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. 16, 2024

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 ARTICLE 1 ? SUBJECTIVITY 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:

Type of inspection: Renewal Date of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 02/16/2024 8:00am until 12:00pm 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: 7 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 4 Number of staff records reviewed: 3 Number of interviews conducted with residents: 2 Number of interviews conducted with staff: 2 An exit meeting will be conducted to review the inspection findings. 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 Cynthia Ball-Beckner, Licensing Inspector at 540-309-2968 or by email at cynthia.ball@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-250-D
Description:	Based on staff record review, the facility failed to ensure that an annual screening for tuberculosis was maintained for all staff. EVIDENCE: 1. The record for staff person 3 has documentation that the last screening for tuberculosis was completed on 07/25/2022.
Plan of Correction:	The administrator has obtained a current copy of staff person 3?s tuberculosis and placed it in their record. The administrator will ensure that all staff have copies of their annual screenings for tuberculosis placed in the records. 02/16/2024
Standard #:	22VAC40-73-440-D
Description:	Based on resident record reviews, the facility failed to ensure that uniform assessment instruments (UAI) were completed as required. EVIDENCE: 1. The record for resident 2 has a physician order dated 01/09/2024 for a puree diet. The UAI dated 01/02/2024 in the record for resident 2 has not been updated to reflect this assessed need as it has the resident 2 does not require any assistance with eating/feeding.
Plan of Correction:	The administrator has updated resident 2?s UAI to reflect current assessed needs. 02/16/2024
Standard #:	22VAC40-73-610-B
Description:	Based on observations of the facility physical plant, the facility failed to ensure that the posted menu was dated for the current week. EVIDENCE: 1. The menu post in the facility on 02/16/2024, did not contain any dates to reflect that it is the current weeks menu.
Plan of Correction:	The administrator has updated the facility posted menu with the dates of the current week 02/16/2024
Standard #:	22VAC40-73-640-D
Description:	Based on observation of the facility medication cabinet and staff interview, the facility failed to ensure that a pharmacy reference book, drug guide or medication handbook no more than two years old was readily available for staff who administers medications. EVIDENCE: 1. The drug reference book available in the facility medication room was noted to be dated from 2021. In an interview with staff person 1, it was expressed that this was the only book available in the facility on the day of inspection.
Plan of Correction:	: The administrator has obtained and will ensure that a current drug reference book is maintained at the facility. 02/17/2024