VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Commonwealth Senior Living at Georgian Manor
651 River Walk Parkway
Chesapeake, VA 23320
(757) 436-9618

Current Inspector: Donesia Peoples (757) 353-0430

Inspection Date: June 18, 2019

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 ADMISSION, RETENTION, AND DISCHARGE OF RESIDENTS

Comments:

An unannounced complaint inspection was conducted by two Licensing Inspectors from the Eastern Region on June 18, 2019 from 10:00 a.m. to 3:41 p.m. There were 69 residents in care. During the inspection, discharged residents? records were reviewed. The following was discussed during the inspection: Ensuring the Discharge Notification and Statement form is completely filled out and education on indicating specific reason for discharge. Please submit your ?plan of correction? and ?date to be corrected? for each violation cited on the violation notice and return it within 10 calendar days. The plan of correct must indicate how the violation will be or has been corrected. Just writing the word ?corrected? is not acceptable. The plan of correction must include: 1. Step(s) to correct the noncompliance with the standard(s) 2. Measures to prevent reoccurrence 3. Person(s) responsible for implementing each step and/or monitoring any preventative measures. If you have any questions, please contact your inspector Alexandra Poulter at 757-613-5133 or alexandra.poulter@dss.virginia.gov.

Violations:

Standard #:	22VAC40-73-430-H-1
Complaint related:	No
Description:	Based upon record review, the facility failed to provide to the resident and his legal representative the date on which the resident and his legal representative was notified of the discharge. Evidence: 1. The ?Discharge Notification and Statement? form used by the facility has an area titled `date of discharge notification to resident?; however, the area was left blank for resident #1 and resident #2. 2. Staff #1 confirmed that resident #1 and resident #2?s forms did not contain a date of discharge notification to resident or their legal representatives.
Plan of Correction:	What Has Been Done to Correct? Upon discharge Georgian Manor will issue a dated, written & signed Discharge Statement to the Resident and or their POA with the following contents: actual reason(s) for discharge, efforts made to assist in the discharge, the actual date of the discharge as well as the Residents? destination. How Will Recurrence Be Prevented? A completed Discharge Statement will be uploaded with final billing transmittal into the computer program. Original shall be maintained in the Residents? Administrative file. Person Responsible: Senior Executive Director and/or Business Office Manager