VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Indian River Assisted Living
1012 Justis Street
Chesapeake, VA 23325
(757) 523-4659

Current Inspector: Margaret T Pittman (757) 641-0984

Inspection Date: Feb. 4, 2021 , Feb. 17, 2021 , Feb. 18, 2021 and Feb. 19, 2021

Complaint Related: No

Areas Reviewed:

22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-73 RESIDENT ACCOMODATIONS AND RELATED PROVISIONS 22VAC40-90 The Sworn Statement or Affirmation

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 February 4, 2021 and concluded on February 19, 2021. The Administrator was contacted by telephone to initiate the inspection. The Administrator reported that the current census was 89. The inspector emailed the Administrator a list of items required to complete the inspection. The inspector reviewed 7 resident records, 5 staff records, menus, activities calendars, staff calendars, health inspection, fire inspection, and resident council notes 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. Consultation was provided regarding Healthcare Oversight, Individualized Service Plans containing appropriate contacts, Activity lengths, Schedules, Training Documentation Requirements.

Violations:

Standard #:	22VAC40-73-610-B
Description:	Based on record review and discussion, the facility failed to ensure menus for meals documented substitutions or additions shall be recorded on the posted menu. Evidence: 1. The facility failed to specify items served on the menu each day of January and February 2021 for items such as ?Juice of Choice?, ?Beverage of Choice? ?Cold Cereal or Hot Cereal?, ?Fruit of the Day?, and ?Mixed Vegetables?. 2. Staff #1 could not provide the menu with documented substitutions and additions recorded on the posted menu.
Plan of Correction:	Menu will be changed to specify type of drink, fruit etc. Dietician approved menu substitutions will be noted on the posted weekly menus and the daily menu printouts for all residents to review. Daily Menu printouts with noted substitutions will be filed with the weekly menu for record keeping and available upon request.
Standard #:	22VAC40-73-830-E
Description:	Based on record review and discussion, the facility failed to provide a written response to the council prior to the next meeting regarding any recommendations made by the council for resolution of problems or concerns. Evidence: 1. December 2020 and January 2021 Resident Council notes were reviewed. No documentation was provided of a written response to the council for either month. 2. Staff #1 confirmed there was no documentation of written response to the residents.
Plan of Correction:	Reviewed Resident Council regulations with Activity Coordinator. Activity Coordinator revised the council meeting minutes note taking process. Administrator will review the draft of meeting minutes to ensure all written responses, notification method, and date of responses are properly recorded for documentation moving forward. Issues are to be addressed, if possible, within a week of the monthly Resident Council meeting.
Standard #:	22VAC40-90-30-C
Description:	Any person making a materially false statement on the sworn statement or affirmation shall be guilty of a Class 1 misdemeanor. Evidence: 1. The following staff checked ?No? on the question, ?Have you ever been convicted of a law violation(s) but excluding offenses committed before your eighteenth birthday that were finally adjudicated in a juvenile court or under a youth offender law??: Staff #2, Staff #3, Staff #4, Staff #5, and Staff #6. 2. Staff #1 confirmed the aforementioned staff?s sworn statement or affirmation contained materially false statements contradicting the ?Criminal History Request Response? received.
Plan of Correction:	IRAL created a ?New Hire Check List? sheet to ensure all Sworn Statements, background checks & applications are properly filled out with the Administrator & BOM during new hire process. All current employee?s Sworn Statements & background checks will be audited for discrepancies. BOM will meet individually with staff who have improperly filled out Sworn Statements. BOM will review the purpose of the form and the consequences of falsifying information on the Sworn Statement. An opportunity to correct each form will be given at this time. During the application/orientation process, Administrator & BOM will ensure each applicant thoroughly reads & answers Sworn Statement truthfully. Each application will now include a Sworn Statement with ?Class I Misdemeanor? highlighted to ensure it is properly seen and read by the applicant.