VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Oakland Manor LLC 2
1836 Matoax Avenue
Petersburg, VA 23805
(804) 451-0693

Current Inspector: Belinda Dyson (804) 662-9780

Inspection Date: Nov. 5, 2020

Complaint Related: No

Areas Reviewed:

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 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:

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 11/5/2020 and concluded on 11/09/2020. The Manager was contacted by telephone to initiate the inspection. The Manager reported that the current census was 4. The Inspector emailed the Manager and Administrator a list of items required to complete the inspection The Inspector reviewed 2 resident records, 2 staff records, medication administration records, physician's orders, staff schedules, pharmacy/medication review, health care and dietitian oversights, and fire drills submitted by the facility to ensure documentation was complete. Information gathered during the inspection determined non compliance with applicable standards or law and violations were documented on the violations notice issued to the facility.

Violations:

Standard #:	22VAC40-73-320-A
Description:	Based on a review of the physical forms, one out of two records reviewed, physical form did not have all of the required information. Evidence: Resident's # 2 physical form does not have a statement that specifies whether the resident is or is not capable of self administering medication.
Plan of Correction:	Administrator and designated staff member will review all physical forms upon admission to make sure all required information is included. Administrator will have family member to use the designated form to be completed by physician and it will be filed in resident's record upon receipt.
Standard #:	22VAC40-73-450-C
Description:	Based on a review of 2 resident's records, all identified needs were not included on the residents individualized service plans. Evidence: Residents #1 and #2 uniform assessment instruments/ physical forms list mental health and or case management services as an identified need, required specifics on addressing these needs were not included on the plans reviewed.
Plan of Correction:	Administrator and designated staff will review residents uniformed assessment instruments and physicals to make sure all areas of need are identified and placed on the service plans to address.
Standard #:	22VAC40-73-450-E
Description:	Based on a review of resident's individualized service plans, all required items were not documented. Evidence: One out of two resident's individualized service plans reviewed was not dated by the person who developed the plan or the resident or his legal representative.
Plan of Correction:	Administrator and designated staff member will review all individualized service plans to make sure all are signed and dated when reviewed a completed with resident and or responsible party.