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Cary Adult Home
7336 Cary Avenue
Gloucester, VA 23061
(804) 693-7035

Current Inspector: Willie Barnes (757) 439-6815

Inspection Date: March 14, 2019 and March 19, 2019

Complaint Related: No

Areas Reviewed:
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

Comments:
A renewal study was conducted at Cary Avenue Adult Home on March 14, 2019 and March 19, 2019. The purpose of inspection is to conduct and unannounced review of this facility with a primary focus on the above standards. (2:45pm-4:42pm; 12:30pm-5:15pm). There were 57 residents in care. Observations, reviews of facility's records and interviews with residents and staff members were conducted during this inspection visit. Violations cited were discussed with the administrator (3/21/2019). Inspection completed by former LI. Re-entered due to technical issues.

Violations:
Standard #: 22VAC40-73-250-C
Description: Based on record review, one of nine new staff records revealed that the facility failed to maintain employee personal and social data. Evidence: On 3/19/2019, there was not an original criminal record report in the record of staff #4, hired on 1/17/2019.

Plan of Correction: The original criminal record was done prior to employment and was misfiled. Manager to do a monthly audit of HR records to insure correct filing.

Standard #: 22VAC40-73-325-A
Description: Based on record review and interview, three of eleven resident records, the facility failed to complete a written fall risk rating by the time the comprehensive ISP was completed. Evidence: During the resident record review, the following residents met the criteria for assisted living care but did not have a written fall risk rating by the completion of a comprehensive ISP: 1. Resident #1, date of admission (DOA)- 12/3/2018, comprehensive ISP completed (12/3/2018). LI and staff #4 could not find a fall risk rating. 2. Resident #2, DOA 2/15/2019, comprehensive ISP completed on 2/15/2019. 3. Resident #3, DOA 2/15/2019, comprehensive ISP completed on 2/15/2019. 4. Staff #4 confirmed a written fall risk rating was not completed for residents 1-3.

Plan of Correction: Upon admission and/or any incidents/falls and yearly, a Fall Risk Assessment will be completed on all clients. ISPs will include comprehensive information with Fall Risk Assessment done by Administrator or designee and Reviewed monthly.

Standard #: 22VAC40-73-325-B
Description: Based on record review and interview, in one of eleven resident records, the facility failed to ensure a fall risk rating be reviewed and updated after a fall. Evidence: During the inspection conducted on 3/19/2019, there was no documentation of Resident #3's fall on 1/25/2019. The incident report dated 1/25/2019 stated resident #3 fell hurting left leg and refused to go to the hospital. Staff #4 confirmed a written fall risk rating was not completed or updated for resident #4.

Plan of Correction: Upon admission an any subsequent incidents/falls and yearly Fall Risk Assessments will be completed by Administrator or designee on all clients

Standard #: 22VAC40-73-550-G
Description: Based on record review and interview, one of three resident records, the facility failed to ensure that residents have been informed annually of the rights and responsibilities. Evidence: On 3/19/2019, licensing inspector review of resident #6's (Date of Admission (DOA) 6/8/2012) record revealed there was not a written acknowledgement of the annual resident rights review; last resident rights dated 3/1/2018. Staff #4 confirmed there was not a written acknowledgement of the annual resident rights review.

Plan of Correction: Upon admission and yearly all clients Rights and Responsibilities are reviewed with all clients and signed. A data base is used to monitor these records. Monthly reports will be run to ensure all clients forms are signed.

Disclaimer:
A compliance history is in no way a rating for a facility++.

The online compliance history includes only information after July 1, 2003. In addition, the online compliance history includes information regarding adverse actions that may be the subject of a pending appeal. An adverse action is not final until a provider has exhausted or waived all due process rights. For compliance history prior to July 1, 2003, or information regarding the status of pending adverse actions, please contact the Licensing Inspector listed in the facility's information. The Virginia Department of Social Services (VDSS) is not responsible for any errors in or omissions from the compliance history information.

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