VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Holly Haven #7
230 High Street
La crosse, VA 23950
(434) 757-1763

Current Inspector: Belinda Dyson (804) 662-9780

Inspection Date: Sept. 9, 2019

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 ACCOMODATIONS AND RELATED PROVISIONS 22VAC40-73 BUILDING AND GROUNDS 22VAC40-73 EMERGENCY PREPAREDNESS 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS Article 1 Subjectivity

Comments:

An unannounced monitoring inspection was completed by 2 Licensing Inspectors from 12:10 p.m.-2:15 p.m.Follow up as completed on the previous violation notice and all violations were corrected. The facility is licensed for 16 residents and 13 residents are in care at this time. There were 5 residents on the premises and 3 staff members on duty during the inspection. The Administrator was present during the inspection. A tour of the physical plant was completed. Physician's orders, medication administration records and medications were reviewed. The facility continues to use an electronic system for medication administration. A sample size of 6 resident's records and 3 staff records were reviewed for compliance.All new personnel records were reviewed since last inspection for criminal history reports and all were in compliance. Lunch meal was observed and residents interviewed did not voice any concerns or complaints. The area of non compliance is identified within this report. Thank you for your assistance during this inspection.

Violations:

Standard #:	22VAC40-73-440-H
Description:	Based on review of resident's records, 1 out of six records reviewed did not have a current annual uniform assessment instrument completed. Evidence: Resident's #3 Uniform Assessment Instrument was dated 6/7/2018.
Plan of Correction:	Administrator will contact the resident's case manager to schedule the assessment for the resident. Once completed it will be filed in the resident's record. Case managers will be contacted in advance to schedule assessments timely in the future.