VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Oakland Manor
1830 Matoax Avenue
Petersburg, VA 23805
(804) 722-3692

Current Inspector: Yvonne Randolph (804) 662-7454

Inspection Date: Dec. 8, 2020 and Dec. 9, 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 RESIDENT ACCOMODATIONS AND RELATED PROVISIONS 22VAC40-73 BUILDING AND GROUNDS 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS Article 1 Subjectivity

Technical Assistance:

Allowable Variance form provided for Standard 30.A

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 11/8/2020 and concluded on 12/9/2020. The facility's CEO was contacted by telephone and email to initiate the inspection. The facility's CEO reported that the current census is two (2). The inspector emailed the CEO a list of items required to complete the inspection. The inspector reviewed two (2) resident records, two (2) staff records, and other required documents submitted by the facility to determine compliance. 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 #:	22VAC40-73-1100-A
Description:	Based on a review of two resident files, the facility failed to (1) obtain written approval for placement of the residents in the home which is licensed as a safe, secure environment and (2) obtain the written approval in the order of priority. This is a repeat violation that was also cited at the last inspection on 1/3/2020. Evidence: The "Approval for Placement In Special Care Unit" form for both residents that was submitted to licensing for review on 12/9/2020 did not contain a signature denoting approval. The line on the form for an approval signature was blank.
Plan of Correction:	Approval for placement of resident in the home were mailed to the adult siblings of the residents. Oakland awaiting the placement forms to file in the case management book. Administrator/licensee will follow-up the regarding the placement form. Effective immediately licensee will include this form as part of the admission packet for compliance.
Standard #:	22VAC40-73-1100-C
Description:	Based on a review of two resident files, the facility failed to document that the order of priority was followed for approval of placement of the resident in a secure environment. Evidence: Independent physician was checked on the "Approval for Placement In Special Care Unit" form for both residents as the person who approved placement in the safe, secure environment. Independent physician is the last choice on the list of priority. There was no explanation of why approval was not obtained from each individual higher on the list of priority.
Plan of Correction:	Resident adult siblings were notified to sign the placement form and will return the form within a week. The licensee will ensure that the order of priority will be followed for approval.
Standard #:	22VAC40-73-1130-A
Description:	Based on a review of staff schedules, the facility failed to maintain at least two direct care staff members awake and on duty at all times. Evidence: Licensing staff reviewed the staff schedule submitted with the renewal application and the staff schedule submitted for the remote renewal. One direct care staff member is listed on all shifts on Saturday and Sunday and on the 7 pm - 7 am shift Monday to Friday.
Plan of Correction:	Due to COVID-19, licensee has had staffing shortages and has been unable to have two staff on shift for the two residents. A variance was requested to have only one staff. Once the facility has two more admissions, licensee will ensure two staff to be on shift per policy.