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Cary Adult Home
7336 Cary Avenue
Gloucester, VA 23061
(804) 693-7035

Current Inspector: Willie Barnes (757) 439-6815

Inspection Date: Feb. 4, 2021 , Feb. 8, 2021 and Feb. 12, 2021

Complaint Related: No

Areas Reviewed:
22VAC40-90 Background Checks for Assisted Living Facilities
22VAC40-90 The Sworn Statement or Affirmation
22VAC40-90 The Criminal History Record Report

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 2-4-21. The administrator was contacted by telephone to initiate the inspection. The administrator reported that the census was 52. The inspector emailed the administrator a list of items required to complete the inspection. The inspector reviewed four resident records, four staff records, staff schedule, fire and emergency drills, pharmacy review and nutrition report submitted by the facility to ensure documentation was complete.
Information gathered during the inspection determined non-compliances with applicable standard or law, and violations were documented on the violation notice issued to the facility.

Standard #: 22VAC40-73-210-A
Description: Based on record review and staff interview, the facility, licensed for only residential living care, failed to ensure direct care staff attended at least 14 hours of training annually for one of four staff.

1. Staff #3's training record documented 11 of the 14 hours of annual training required.
2. On 2-12-21, staff #1, acknowledged, staff's record did not include required 14 hours.

Plan of Correction: Will ensure all staff complete required hours of training each year, as state of emergency mandates allow.

Standard #: 22VAC40-73-440-H
Description: Based on record review and staff interview, the facility failed to ensure an annual reassessment, using the uniformed assessment instrument (UAI) was utilized to determine whether a resident's needs can continue to be met by the facility and whether continued placement in the facility is in the best interest of one of four residents.

1. A review of the uniformed assessment instrument (UAI) for resident #3 was last dated 12-17-19. Resident's date of admission was documented as 6-2-20.
2. On 2-12-21, staff #1 acknowledged resident's UAI was not updated annually.

Plan of Correction: Will ensure all UAIs are completed on an annual basis.

Standard #: 22VAC40-73-450-C
Description: Based on record review and staff interview, the facility failed to ensure the individualized service plan (ISP) included all assessed needs for two of four residents.

1. Resident #1's uniformed assessment instrument (UAI) dated 11-5-20 documented stairclimbing as not performed. The individualized service plan (ISP) dated 1-2-21 did not include the assessed stairclimbing need. Resident's physical examination dated 11-23-20 and UAI documented resident's lower right and left legs are amputated.
a. Resident's nurses notes dated 12-2-20 at 11:30 a.m.(date of admission) documented by staff #1, resident transfers with use of a slide board. This information not documented on ISP and acknowledged by staff #1 on 1-16-21.
2. Resident #2's physician's order forms dated 10-8-20 and 2-1-21 documented resident allergic to Haldol. This information is not documented on the ISP dated 10-19-20.
a. Resident's uniformed assessment instrument (UAI) dated 10-19-20 documented case manager provide case management services from an external agency. This information not on ISP.
3.. Staff #1 acknowledged on 2-12-21 all assessed needs not documented on residents' ISP.

Plan of Correction: 1. Will continue to have wheelchair (w/) bound resident use ramp vs. stairs and document w/c use.
2. Will ensure all allergies, case management services, and use of adaptive equipment are included on ISPs.

Ongoing and 2/24/21

Standard #: 22VAC40-73-550-G
Description: Based on record review and staff interview, the facility failed to ensure the rights and responsibilities of residents in assisted living facilities was reviewed annually with one of four staff.

1. Staff #3's record did not document an annual review of resident's rights. The date of the last review of resident's rights was dated 2-1-20; staff's date of hire documented as 2-1-19.
2. On 2-12-21, staff #1 acknowledged resident's right was not reviewed annually.

Plan of Correction: Will ensure all documents, do include resident's rights, are reviewed/signed by all staff on an annual basis as needed.

A compliance history is in no way a rating for a facility++.

The online compliance history includes only information after July 1, 2003. In addition, the online compliance history includes information regarding adverse actions that may be the subject of a pending appeal. An adverse action is not final until a provider has exhausted or waived all due process rights. For compliance history prior to July 1, 2003, or information regarding the status of pending adverse actions, please contact the Licensing Inspector listed in the facility's information. The Virginia Department of Social Services (VDSS) is not responsible for any errors in or omissions from the compliance history information.