VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Havenwood
50 Havenwood Drive
Lexington, VA 24450
(540) 463-2205

Current Inspector: Jennifer Stokes (540) 589-5216

Inspection Date: Nov. 6, 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 32.1 Reported by persons other than physicians 63.2 General Provisions. 63.2 Protection of adults and reporting. 63.2 Licensure and Registration Procedures 63.2 Facilities and Programs.. 22VAC40-90 Background Checks for Assisted Living Facilities 22VAC40-90 The Sworn Statement or Affirmation 22VAC40-90 The Criminal History Record Report 22VAC40-80 THE LICENSE. 22VAC40-80 THE LICENSING PROCESS. 22VAC40-80 SANCTIONS.

Comments:

On 11/6/2019 one inspector conducted an annual monitoring visit (10:40 AM to 4:10 PM). 21 residents were in care. Six resident records and three staff records were fully reviewed, and all new staff records were reviewed for background checks. One companion/sitter record was reviewed. A medication pass and meal were observed. Activities were observed. Residents, family, and staff were interviewed. A physical plan tour was done. During the inspection and at the exit interview, the facility was given the opportunity to discuss the violations and to show that they were in compliance. Please complete the plan of correction and date to be corrected for each violation cited on the violation notice and return it to your licensing inspector 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 the following: 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). If you have any questions, please contact your licensing inspector at 540-309-3043.

Violations:

Standard #:	22VAC40-73-220-B
Description:	Based on record review, the facility failed to obtain, in writing, information on the type and frequency of the services to be delivered to a resident by private duty personnel. EVIDENCE: 1. The record for staff 5 (private duty companion) lacks information information on the type and frequency of the services to be delivered to a resident by private duty personnel.
Plan of Correction:	Staff record was updated 11/15/19 with services delivered to resident with type and frequency. Administrator will add requirement to private duty checklist.
Standard #:	22VAC40-73-250-D
Description:	Based on staff record review, the facility failed to obtain a TB screening on a new staff person before they began work. EVIDENCE: 1. Staff 3 began work on 10/20/2019, and the staff file lacks documentation to support that a TB screening was done.
Plan of Correction:	Staff record had consent form and roof of skin test on 10/17/17 but did not return to have read. ADMINISTRATOR SENT STAFF for TB Assessment on 11/7/19 and staff returned same day with neg. assessment. ADMINISTRATOR will review TB assessment paperwork for accuracy and completion during hiring process
Standard #:	22VAC40-73-320-A
Description:	Based on document review, the facility failed to obtain required information on a pre-admission physical exam for a resident. EVIDENCE: 1. The physical exam form for resident 1, dated 9/11/2019, lacks information regarding the reactions to some allergens: niacin, sulfanilamide, insositol.
Plan of Correction:	Reaction to drugs are unknown by Doctor and Resident. Documented unknown reaction by V.O. of Doctor. Administrator will review physical form for completion.
Standard #:	22VAC40-73-350-B
Description:	Based on resident record review, the facility failed to obtain a sex offender screening prior to admittance. EVIDENCE: 1. The file for resident 4, admitted 8/22/2019, lacks documentation to support that a pre-admission sex offender screening was obtained.
Plan of Correction:	Resident sex offender check was completed on day of inspection & placed in file. Administrator will make sure all items on resident file checklist are complete prior to admission.
Standard #:	22VAC40-73-450-C
Description:	Based on resident record review, the facility failed to address some needs on comprehensive individualized service plans (ISP). EVIDENCE: 1. The uniform assessment instrument (UAI) for resident 4 shows this resident needs mechanical and human help with physical assistance when transferring. This need is not addressed on the ISP, dated 9/5/2019.
Plan of Correction:	Resident ISP was updated on day of inspection and signed by POA on 11/07/19. ADMINISTRATOR will monitor UAI and ISP for accuracy during health care oversight. Also gave staff technical assistance on completion of ISP in unison with UAI.