VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Gray Ridge Village LLC
155 Ridgefield Rd
Marion, VA 24354
(276) 521-0784

Current Inspector: Rebecca Berry (276) 608-3514

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 EMERGENCY PREPAREDNESS 22VAC40-90 The Sworn Statement or Affirmation 22VAC40-90 The Criminal History Record Report

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 monitoring inspection was initiated on 05/19/2020 and concluded on 05/20/2020. The administrator was contacted by telephone to initiate the inspection. The administrator reported that the current census was 65. The inspector emailed the administrator a list of items required to complete the inspection. The inspector reviewed 4 resident records, 4 staff records, staff schedules for the past two weeks, most recent fire inspection, most recent health inspection, most recent health department inspection report, fire and emergency drills for the past 3 months was 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.

Violations:

Standard #:	22VAC40-73-70-A
Description:	Based on resident records review and facility nursing notes, the facility failed to report one incident within 24 hours for one resident in care. EVIDENCE: 1. According to nursing notes for resident #3 dated 5/17/2020 this resident was sent out to the hospital via ambulance after bruising and a blister was discovered on her left knee. This resident stated she had fallen the Thursday prior to this date and requested to be sent to the Emergency Department. This resident is to follow up with an orthopedic doctor. The Licensing Office did not receive an incident report for this resident within 24 hours of occurrence.
Plan of Correction:	All incidents that require ER visit will be reported to licensing within 24 hours. Administration will monitor/RCD will monitor [sic].
Standard #:	22VAC40-73-620-A
Description:	Based on documentation review, the facility failed to ensure oversight of special diets are complete every six months by a dietitian or nutritionist for each resident who has such a diet. EVIDENCE: 1. The Administrator stated a dietary review had been done by a dietitian recently. However, the paperwork could not be located within the facility to verify the review was completed and therefore the paperwork was not submitted to the Licensing Inspector.
Plan of Correction:	Facility will ensure oversight of special diets are completed every 6 months by a nutritionist and kept on file. Admin will monitor. [sic]