VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Cha Cha's Care Home, LLC
6291 Simi Court
Mechanicsville, VA 23111
(804) 252-0967

Current Inspector: Belinda Dyson (804) 662-9780

Inspection Date: March 13, 2020

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 22VAC40-90 Background Checks for Assisted Living Facilities 22VAC40-90 The Sworn Statement or Affirmation 22VAC40-90 The Criminal History Record Report 22VAC40-80 THE LICENSE.

Comments:

An unannounced monitoring inspection was completed by 2 Licensing Inspectors from 1:30 p.m.-400 p.m. Follow up was completed on the previous violation notice and all violations were corrected. A sample size of 4 residents records and 4 staff records were reviewed for compliance.No new staff have been hired since last inspection. A tour of the physical plant was completed. The census was reported as 8 residents in care at this time. The facility is licensed for residential and assisted living level of care. The Administrator was present during the inspection. A medication administration pass, physician's orders and medications were observed. Residents did not express any concerns or complaints.Violations cited are identified within this report. Please complete the plan of correction and date to be corrected for each violation cited on the violation notice and return to the Inspector within or by 10 days. You will need to specify how the deficient practice will be corrected. Just writing the word ?corrected? is not acceptable. Your plan must contain 1) steps to correct the non-compliance with the standards, 2) measures to prevent the non-compliance from occurring again, and 3) person(s) responsible for implementing each step and or monitoring any preventative measure(s). Please contact my office if I can be of any further assistance

Violations:

Standard #:	22VAC40-73-320-B
Description:	Based on a review of residents records, one out of four records reviewed did not have a current tuberculosis screening documented. Evidence: Resident's #2 annual tuberculosis risk assessment was dated 2/19/19.
Plan of Correction:	Administrator scheduled the risk assessment form to be completed on the identified resident. The risk assessment was done and filed in the resident's record. All resident's records will be audited to make sure annual current TB risk assessments are done on a new form and placed in the resident's record.
Standard #:	22VAC40-73-690-B
Description:	Based on a review of the medication (pharmacy) review, it has not been completed every six months and was not current for the residents assessed as assisted living level of care. Evidence: The last medication review by pharmacy was dated 2/12/2019.
Plan of Correction:	Administrator had contacted Pharmacy for a review of medications. Due to the COVID -19 virus the pharmacy will inform the facility when they can perform the medication review. We have included in our monthly checklist to make sure the review is done timely every six months as required.
Standard #:	22VAC40-73-720-A
Description:	Based on a review of resident's records, one out of four records reviewed did not have all required DNR information on the individualized service plan. Evidence: DNR was highlighted at the top of Resident's #4 individualized service plan, however DNR detailed information was not included in the body of the form.
Plan of Correction:	Administrator or designated staff member will review the resident's ISP and make sure all required detailed information is added. All resident's charts will be audited to make sure that all detailed required information of the DNR order is included in the ISP.