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: July 17, 2020

Complaint Related: No

Areas Reviewed:

22VAC40-73 GENERAL PROVISIONS 22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES 22VAC40-73 PERSONNEL 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 Background Checks for Assisted Living Facilities 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 renewal inspection was initiated on 07/13/2020 and concluded on 07/17/2020. The Administrator was contacted by telephone to initiate the inspection. The administrator reported that the current census was 63. The inspector emailed the administrator a list of items required to complete the inspection. The inspector reviewed 4 resident records, 4 staff records, the staff schedule for the past two weeks, the most recent health care and dietitian oversight, the most recent fire and health inspections, fire and emergency drills for the past three months, and criminal record checks and sworn disclosures for all new hires since the last inspection 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 #:	22VAC40-73-320-A
Description:	Based on review of resident records and physical examination reports, the facility failed to ensure all required information was contained on the physical examination report for one resident in care. EVIDENCE: 1. Resident # 2 was admitted to the facility on 1/23/2020. The physical exam for this resident dated 01/09/2020 did not include descriptions for reactions to Penicillin, Sulfa, Keflex, Blaxin, Codeine, or Sinemet listed as allergies for this resident. 2. Resident # 4 was admitted to the facility on 06/03/2020. The physical exam for this resident dated 06/03/2020 did not include the resident's address, telephone number, height, weight, or the description of reactions to Codine, Lidocaine, or Clozapine listed as allergies for this resident.
Plan of Correction:	All required information will be listed on the physical report upon admission. RCD will monitor Admin will monitor. [sic]
Standard #:	22VAC40-90-40-B
Description:	Based on review of new employee records and criminal history reports, the facility failed to obtain a criminal history report for one employee on or prior to the 30th day of employment. EVIDENCE: 1. Staff # 5 has a hire date of 05/28/2020 with the facility. As of the inspection date 07/17/2020 a criminal history record has not been obtained for this staff member.
Plan of Correction:	All background checks will be back within 30 days-Admin will call after 20 days if it is not returned at that point; Admin will attempt to set up background checks online via the state police. Admin will monitor. [sic]