VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Indian River Assisted Living
1012 Justis Street
Chesapeake, VA 23325
(757) 523-4659

Current Inspector: Margaret T Pittman (757) 641-0984

Inspection Date: July 23, 2019

Complaint Related: No

Areas Reviewed:

22VAC40-73 BUILDING AND GROUNDS

Comments:

Two licensing inspectors conducted the initial inspection on July 23, 2019. The owner of the facility, as well as administrative staff were present during the inspection. The administrator and nursing staff were present during the tour of physical plant. Inspectors provided copies of Inspection Protocol forms to the providers as a suggested reference tool. Related standards were discussed and suggestions provided. Advised to remove items and/or equipment that have been replaced and are not in use (i.e. toilet paper holders.) Please note that Alexandra Poulter is the inspector assigned to the facility. 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 #:	22VAC40-73-870-A
Description:	Based on observation, the facility failed to ensure that the interior of the building was maintained in good repair and kept clean. Evidence: 1. During a tour of the facility, the following was observed: a. Room 27 had blackish-brown substance coating the surface of the floor on the far side of the bed from the entrance, and dark tan-brownish stain with peeling paint along the baseboard on the wall beneath the window that extended the length of the wall towards the client?s bed. b. Room 37 bathroom had chipped paint that covered 2/12 inches by the toilet paper dispenser, and the toilet was detached from the floor. The wall behind the resident?s chair had a crack approximately two feet long across the wall exposing the sheet rock. c. Room 43 bathroom floor baseboard located to the right of the vanity and left of the toilet was detached from the floor. d. Room 51 bathroom floor tiles had rust colored substance between the bedroom and bathroom on the floor. The bedroom wall had a yellowish-brown colored stain that was approximately 5 inches in diameter along the wall behind the wardrobe. e. Room 25 window was unable to shut at the bottom, creating a half inch gap. f. Room 27 window screen had multiple circular holes. The largest hole measuring approximately 8 inches in diameter. 2. Staff #1 confirmed the aforementioned areas that were not in good repair and kept clean.
Plan of Correction:	a. All areas of chipped and/or stained paint have been painted and repaired by company contractor. Painted surfaces will be maintained in a state of good repair. This will be monitored on a daily basis by administrator, housekeeping, and maintenance personnel. b. Toilet has been securely attached to floor. All toilets will be maintained in good repair and secured to the floor to assure resident safety. This will be monitored on a daily basis by administrator, housekeeping, and maintenance staff. c. Baseboard has been replaced. All baseboard will be secured to wall. This will be monitored on a daily basis by administrator, housekeeping, and maintenance staff. d. All tiles have been cleaned or replaced. Tiles will be maintained in a clean and good state of repair. This will be monitored on a daily basis by administrator, housekeeping, and maintenance staff. e. Window has been repaired. All windows will open and close as required. This will be monitored on a daily basis by administrator, housekeeping, and maintenance staff. f. Screen has been replaced. All screens will be maintained in a state of good repair. This will be monitored on a daily basis by administrator, housekeeping, and maintenance staff.