VIRGINIA DEPARTMENT OF SOCIAL SERVICES

The Haven Assisted Living @ Studley
7436 Studley Road
Mechanicsville, VA 23116
(804) 779-4847

Current Inspector: Kimberly Davis (804) 662-7578

Inspection Date: May 20, 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 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.

Comments:

This inspection was conducted by licensing staff using an alternate remote protocol necessary due to a state of emergency health pandemic declared by the Governor of Virginia. A renewal inspection was initiated on May 18, 2020 and concluded on May 20, 2020. The administrator was contacted by telephone to initiate the inspection. The administrator reported that the current census was 6. The inspector emailed the administrator a list of items required to complete the inspection. The inspector reviewed 2 resident records, 2 staff records, and other facility documentation submitted by the facility to ensure documentation was complete. Information gathered during the inspection determined non-compliance(s) with applicable standards or law, and violations were documented on the violation notice issued to the facility. Please complete the "plan of correction" and "date to be corrected" for each violation cited on the violation notice and return it to the licensing office within 10 calendar days. Please specify how the violation will be corrected. The plan must contain: 1) step(s) to correct the non-compliance with the standard(s), 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). Thank you for your cooperation during this inspection. I can be reached at Kimberly.M.Davis@dss.virginia.gov or (804) 662-7578.

Violations:

Standard #:	22VAC40-73-290-A
Description:	Based on a review of facility documentation, the facility failed to ensure that it maintained a work schedule that included the names and job classifications of all staff working each shift, with any absences, substitutions, or other changes noted on the schedule. Evidence: The facility submitted a sheet with the heading "Staff Information Sheet/Monthly Schedule (including weekends) Month of May 2020 " that only listed names of the administrator, manager, and medication aids. The sheet noted "Primary Care Staff 9 a.m.- 9 a.m. (live-in)", but did not include the names of those staff or dates/hours worked.
Plan of Correction:	Administrator will ensure the primary care staff is listed on the staff information sheet. The staff information sheet was corrected and posted the same day.
Standard #:	22VAC40-73-450-C
Description:	Based on a review of resident records, the facility failed to ensure that each resident's Individualized Service Plan (ISP) contained a written description to address all identified needs. Evidence: - Resident # 1's Uniform Assessment Instrument (UAI) dated 4-29-2020 indicated that resident needs help with walking and stairclimbing, however, the needs were not addressed on the resident's ISP dated 4-29-2020. -Resident's # 2's UAI dated 4-19-2020 indicated that resident needs help with walking and stairclimbing, however, the needs were not addressed on resident's ISP dated 4-19-2020.
Plan of Correction:	ISPs for Resident # 1 and Resident # 2 have been corrected to reflect the residents' needs noted on the UAI.
Standard #:	22VAC40-73-650-C
Description:	Based on a review of resident records, the facility failed to ensure that physician's or other prescriber's orders were signed by a physician or other prescriber within 14 days. Evidence: Physician's orders for Resident # 1 and Resident # 2 did not contain a physician's signature. The only signature on the physician's orders, written in the section "Meds reviewed by", was that of Natasha Goins who is the facility manager.
Plan of Correction:	Administrator will ensure all residents' orders will be signed by the doctor. Orders were signed by the doctor and placed in the residents' file the same day.
Standard #:	22VAC40-73-690-B
Description:	Based on a review of resident records, the facility failed to ensure that a review of all the medications for each resident was performed every six months. Evidence: Medication/Pharmacy review for Resident # 1 was last dated 8-5-19.
Plan of Correction:	Administrator will ensure pharmacy is contacted in a timely manner to complete medication reviews.