VIRGINIA DEPARTMENT OF SOCIAL SERVICES

The Haven Assisted Living @ Studley
7436 Studley Road
Mechanicsville, VA 23116
(804) 779-4847

Current Inspector: Kimberly Davis (804) 662-7578

Inspection Date: April 15, 2021 , April 16, 2021 and April 20, 2021

Complaint Related: No

Areas Reviewed:

22VAC40-73 GENERAL PROVISIONS 22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES 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 EMERGENCY PREPAREDNESS 32.1 Reported by persons other than physicians 63.2 General Provisions. 63.2 Protection of adults and reporting. 63.2 Licensure and Registration Procedures 63.2 Facilities and Programs.. 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. 22VAC40-80 THE LICENSING PROCESS.

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 April 15, 2021 and concluded on April 20, 2021. The administrator was contacted by telephone to initiate the inspection. The administrator reported that the current census was 3. The inspector emailed the administrator a list of items required to complete the inspection. The inspector reviewed 2 resident records, 2 staff records, physician's orders, Medication Administration Records, and other facility documentation submitted by the facility to ensure documentation was complete. A virtual tour of the facility was also conducted. Information gathered during the inspection determined non-compliance(s) with applicable standards or law, and a violation was documented on the violation notice issued to the facility. Please complete the "plan of correction" and "date to be corrected" for each violation cited on the violation notice and return it to the licensing office within 10 calendar days. Please specify how the violation will be corrected. The plan must contain: 1) step(s) to correct the non-compliance with the standard(s), 2) measures to prevent the non-compliance from occurring again; and 3) person(s) responsible for implementing each step and/or monitoring any preventative measure(s). Thank you for your cooperation during this inspection. I can be reached at Kimberly.M.Davis@dss.virginia.gov or (804) 662-7578.

Violations:

Standard #:	22VAC40-73-710-C
Description:	Based on a review of resident records, the facility failed to ensure that a restraint is imposed with a physician's order that specifies the condition, circumstances, and duration under which the restraint is to be used. Evidence: According to the resident roster submitted by the facility, Resident # 1 uses a restraint. However, the physician's orders for Resident # 1 did not contain an order for a restraint.
Plan of Correction:	Administrator will ensure restraint orders are in place, contacted Dr. and agency to have corrected and place in resident's file.