VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Brookdale Chambrel Williamsburg
3800 TREYBURN DRIVE
Williamsburg, VA 23185
(757) 220-1839

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

Inspection Date: Dec. 5, 2019 and Dec. 10, 2019

Complaint Related: No

Areas Reviewed:

22VAC40-73 RESIDENT CARE AND RELATED SERVICES

Comments:

An unannounced monitoring inspection was conducted on 12-5-19 (ar 09:05 am /dep 17:25 pm) in response to a resident's elopement from the facility's safe, secure environment on the evening of 10-29-19. The facility census was 89. Resident interview and record was reviewed, staff interviewed on various days and times regarding resident's elopement. An exit was conducted on 12-5-19 with the executive director and the administrator. The acknowledgement form was signed by the administrator. Please complete the 'Plan of Correction' and 'Date to be Corrected' for each violation cited on the violation notice and return it to me within 10 calendar days from today (1-6-20). You need to be specific with how the deficiencies either have been or will be corrected to bring you into compliance with the Standards. Your plan of correction must contain the following three points: 1. Steps to correct the noncompliance with the standard(s) 2. Measures to prevent the noncompliance from occurring again 3. Person(s) responsible for implementing each step and/or monitoring any preventive measure(s) Please provide your responses in a Word Document, if possible.

Violations:

Standard #:	22VAC40-73-460-D
Description:	Based on record review and staff interview, the facility failed to ensure it provided supervision of a resident residing on the safe, secure environment to prevent wandering from secure unit. Evidence: 1. On 12-5-19 during interview with staff #3, resident #1 was observed standing on the sidewalk located on the ramp-side of ALF II builiding with rollator walker. Staff #3 did not know resident #1, but did inquire of resident what was the resident looking for. 2. Staff #3 observed staff #4 who was at the front entrance of the building and inquired of staff who the resident was. 3. Staff #4 recognized resident #1 as a resident from the safe, secure environment located on the third floor of the building. Staff #3 went into the building and report to the concierge that resident #1 was outside. The concierge sounded the encoded word for missing person. 4. Staff #1 contacted staff on the third floor to inform of resident #1's elopement. 5. Staff #1 and #5 came and returned resident #1 to the safe, secure unit. 6. During the course of interviews with staff #5 and #6 stated not knowing resident #1 had exited the unit through the side door and went downstairs and out of ALF II building. According to staff, there was no alarm or sound alerting staff that the door was opened. 7. Staff #1 acknowledged resident #1 exited the third floor safe, secure unit on the afternoon of 10-29-19 and went down the stairs with the rollator walker and was located on the sidewalk of ALF II building.
Plan of Correction:	1. The 15 second egress was removed from the door. The Fire Marshall was notified and approved. 2. Re-education will be conducted by the Executive Director / Designee to the associates of the Assisted Living and Crossings no later than January 9th, 2020. 3. The Assisted Living Director / Designee will monitor Egress door alarm system weekly for four (4) weeks for function. 4. The Assisted Living Director / Maintenance Director / Designee will complete mandatory Egress Alarm system checks and maintain in the TELS system ongoing to verify compliance.