VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Victory Assisted Living
27 Centre Hill Ct
Petersburg, VA 23803
(804) 861-8756

Current Inspector: Belinda Dyson (804) 662-9780

Inspection Date: May 1, 2019 and May 3, 2019

Complaint Related: No

Areas Reviewed:

22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES 22VAC40-73 PERSONNEL 22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-73 BUILDING AND GROUNDS

Technical Assistance:

Technical Assistance was provided and encouraged key stay to attend Phase II training. The facility Administrator is encouraged to contact the Licensing Representative for available training dates.

Comments:

Two Licensing Inspectors with the Division of Licensing attempted to conduct an unannounced, mandated, renewal, inspection on 05/01/2019 at 10:00am. The facility was not open at the time and the Licensing Representatives returned on 05/03/2019 and conducted the inspection from 9:10am to 11:04am. During the Inspection the facility staff in-charge was present and the facility Administrator arrived later. The Licensing Representatives reviewed 3 staff records and 6 resident records. The Licensing Staff reviewed the facility medication administration records, physician orders and medication packs. Please complete the "plan of correction" and "date to be corrected" for each violation cited on the violation notice and return it to me within 10 calendar days from today. You will need to specify how the deficient practice will be or has been corrected. Just writing the word "corrected" is not acceptable. Your plan of correction must contain: 1) steps to correct the noncompliance with the standard(s), 2) measures to prevent the noncompliance from occurring again; and 3) person(s) responsible for implementing each step and/or monitoring any preventive measure(s). Please contact the facility Licensing Inspector, Kimberly Rodriguez for additional questions or concerns at 804-662-9787 or by e-mail at kimberly.rodriguez@dss.virginia.gov.

Violations:

Standard #:	22VAC40-73-100-A
Description:	Based on observation of the facility physical plant, the facility failed to implement an infection control program to prevent and control disease and infection that is consistent with federal Centers for Disease Control and Prevention guidelines. Evidence: On 05/03/2019, the resident bathroom contained multiple damp, used resident wash clothes piled on top of each other. Based on Staff statements the wash clothes belonged to the designated residents that used that specified resident rest room.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-250-C
Description:	Based on staff record review the facility failed to ensure staff records contained sworn disclosure statement. Evidence: On 05/03/2019, it was observed that staff #2's record did not contain a sworn disclosure statement.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-250-D
Description:	Based on staff record review, the facility failed to ensure on or within seven days prior to the first day of work at the facility and prior to coming in contact with residents, submitted the results of a risk assessment, documenting the absence of tuberculosis in a communicable form as evidenced by the completion of the current screening form published by the Virginia Department of Health or a form consistent with it. Evidence: On 05/03/2019, it was observed that staff #1 was hired on 03/16/2018 however the risk assessment was not completed until 05/17/2018. Evidence #2: On 05/03/2019, it was observed that staff #2 was hired on 10/18/2018, however the risk assessment was not completed until 04/26/2019.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-670-1
Description:	Based on staff record review the facility failed to ensure that each staff person who administered medication was authorized. Evidence: On 05/03/2019, it was observed that staff #3 had administered medications during the month of April, 2019 and May 2019, however staff #3 was not a medication aide.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-680-H
Description:	Based on resident record review and staff statements, the facility failed to ensure at the time the medication is administered the facility documented on a medication administration record. Evidence: On 05/03/2019, it was observed that resident # 1 did not have a medication administration record for medications administered on 5/1, 5/2 or 5/3/2019.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-870-B
Description:	Based on review of the facility physical plant, the facility failed to ensure the building was free from odors. Evidence: On 05/03/2019, while entering a residents room, the smell of urine was detected which was found to be urine soaked clothing in the residents laundry bin.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-870-E
Description:	Based on a tour of the facility physical plant, the facility failed to ensure all showers were kept clean. Evidence: On 05/03/2019, it was observed that the facility resident shower handles were rusted around the knobs and mold residue was around the shower corners.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-925-A
Description:	Based on observation of the facility physical plant the facility failed to ensure toilet tissue was accessible to each commode. Evidence: On 05/03/2019, it was observed that the first floor facility rest room did not contain any toilet paper. Based on staff statements, toilet paper was provided upon request.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-925-C
Description:	Based on observation of the facility physical plant, the facility failed to ensure residents did not share bar soap. Evidence: On 05/03/2019, it was observed that multiple bars of soap were in the facility rest rooms. The bar soap was not labeled nor in separate containers to ensure soap was not shared.
Plan of Correction:	Not available online. Contact Inspector for more information.