VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Fort Shelby Manor
200 Solar Street
Bristol, VA 24201
(276) 669-3562

Current Inspector: Rebecca Berry (276) 608-3514

Inspection Date: June 11, 2020

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 RESIDENT CARE AND RELATED SERVICES

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 complaint inspection was initiated on 06/09/2020 and concluded on 06/11/2020. A complaint was received by the department regarding allegations in the areas of resident care. The administrator was contacted by telephone to conduct the investigation. The licensing inspector emailed the administrator a list of documentation required to complete the investigation. The evidence gathered during the investigation supported the allegations of non-compliance with standards or law, and violations were issued. Any violations not related to the complaint but identified during the course of the investigation can be found on the violation notice.

Violations:

Standard #:	22VAC40-73-450-H
Complaint related:	No
Description:	Based on information received from the facility and interviews with staff and resident; the facility failed to ensure that the care and services specified in the Individual Service Plan (ISP) were provided for one resident in care. EVIDENCE: 1. Resident # 1 was admitted to the facility on December 4, 2019. 2. The Uniform Assessment Instrument (UAI) for resident # 1 dated 11/21/2019 rates her dependent in bathing. 3. The ISP for resident # 1 dated 12/4/2019 states this resident will be assisted in and out of the shower and assisted with bathing as needed. 4. The resident stated she had not showered in sometime due to being unhappy at the facility. The Administrator stated this resident has had one shower since being admitted to the facility on December 4, 2019 due to refusal by the resident.
Plan of Correction:	The resident was assisted with a bath when she agreed to bathe the ont time while at the facility. Staff will assist any resident who is rated as dependent in bathing. Resident refuses any help therefore we cannot meet her needs. [sic[
Standard #:	22VAC40-73-460-H
Complaint related:	No
Description:	Based on information received by the facility and interview with staff and the resident, the facility failed to ensure that personal assistance and care were provided for one resident in care as necessary so that the needs of the resident are met for bathing at least twice a week. EVIDENCE: Resident # 1 was admitted to the facility on December 4, 2019. 2. The Uniform Assessment Instrument (UAI) for resident # 1 dated 11/21/2019 rates her dependent in bathing. 3. The ISP for resident # 1 dated 12/4/2019 states this resident will be assisted in and out of the shower and assisted with bathing as needed. 4. The resident stated she had not showered in sometime due to being unhappy at the facility. The Administrator stated this resident has had one shower since being admitted to the facility on December 4, 2019 due to refusal by the resident. 5. According to the shower log documented by the facility, resident # 1 refused to shower a total of 32 times. 6. Resident # 1 has continued to reside at the facility and not having her showering need met for the past six months.
Plan of Correction:	Since Fort Shelby Manor cannot meet this resident's needs, she will be given a 14 day notice to be discharged. Fort Shelby Manor will not admit any resident that we cannot meet their needs. [sic]