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: Dec. 27, 2019

Complaint Related: No

Areas Reviewed:

22VAC40-73 RESIDENT CARE AND RELATED SERVICES

Comments:

A Licensing Representative conducted an unannounced monitoring inspection on December 27, 2019 from 2:11 p.m. to 3:46 p.m. regarding a self-reported incident of resident to resident physical abuse. There were 101 residents in care. The following was discussed: Follow up interventions from behaviors and documentation times. 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 correction must indicate how the violation will be or has been corrected. 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 #:	22VAC40-73-440-A
Description:	Based on record review and interview, the facility failed to ensure the Uniform Assessment Instrument (UAI) was completed at least annually. Evidence: 1. Resident #1 admitted on 08-30-17. The most current UAI in resident #1?s record was dated 08-22-18. 2. Staff #2 observed and confirmed resident #1?s UAI had not been completed annually.
Plan of Correction:	The new UAI was received on 12/28/19. The Resident Care Coordinator will review monthly all UAI due dates and work to have them completed in a timely manner. If a Public Pay UAI is not completed in a timely manner we will document all efforts to keep current UAI in the chart.
Standard #:	22VAC40-73-550-C
Description:	Based on record review and interview, the facility failed to ensure residents were free from physical abuse, as provided in 63.2-1808 of the Code of Virginia. Evidence: 1. An incident report received by the regional licensing office on December 21, 2019 documented the following, ?[Resident #1] was in the shared bathroom. [Resident #2] came in the bathroom + told [Resident #1] that she had to ?F__ Pee? + gave [Resident #1] a blow to the face + her glasses flew off. [Resident #1] left very upset + reported the incident immediately to [Staff #1] + the Administrator.? 2. ?Nurse?s Notes? dated Dec 21, 2019 documented, ?[Resident #2] attacked her next door neighbor in the bathroom due to the fact [Resident #3] was taking too long in the bathroom, which they share; reports were written; and APS notified by administration.? 3. During interview with resident #1 on 12-27-19, resident #1 confirmed that resident #2 struck her in the face, and that she was fearful of resident #2. 4. Staff #2 observed and confirmed that resident #1 suffered physical abuse by resident #2 and that resident #1 expressed fearfulness of resident #2.
Plan of Correction:	Residents were reassigned to rooms that did not have adjoining bathrooms. Staff will continue to monitor for both residents and if anything further occurs the aggressor will receive a notice of discharge.