VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Commonwealth Senior Living at King's Grant House
440 North Lynnhaven Road
Va. beach, VA 23452
(757) 431-8825

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

Inspection Date: April 23, 2021 and April 26, 2021

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 ADMISSION, RETENTION, AND DISCHARGE OF RESIDENTS 22VAC40-73 RESIDENT CARE AND RELATED SERVICES

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 complaint investigation was initiated on 04-23-2021 and concluded on 04-26-2021. A complaint was received by the department regarding allegations in the areas of Personal Care Services and General Supervision of Care and Restorative, Habilitative, and Rehabilitative Services. The Administrator was contacted by telephone to conduct the investigation. The licensing inspector emailed the Administrator a list of documentation required to complete the investigation. The evidence gathered during the investigation did not support the allegations of non-compliance with standards or law. Any violations not related to the complaint but identified during the course of the investigation can be found on the violation notice.

Violations:

Standard #:	22VAC40-73-325-C
Complaint related:	No
Description:	Based on record review and interview, the facility failed to document an analysis of the circumstances of the fall and interventions initiated to prevent or reduce risk of subsequent falls for residents who meet the criteria for assisted living care. Evidence: 1. Resident #1's Uniform Assessment Instrument (UAI) dated 12-14-2020, resident #2?s UAI dated 02-11-2021, and resident #4?s UAI dated 03-12-2021 documented the residents? meet criteria for assisted living level of care. 2. Staff ?Progress Notes? indicated the following falls: A. 02-10-2021, resident #1 was observed on the bathroom floor, with evidence of head injury and skin tear to right shoulder; B. 02-28-2021, resident #2 fell in room and c/o [complained of] pain; and C. 04-06-2021, resident #3 was found on the floor; and on 04-16-2021 resident was found on the floor with injury on forehead. 3. Staff #1 stated ?On the documentation for analysis and interventions you requested for each of the 3 residents [residents #1, #2, and #3 listed above, we do not have.? 4. Staff #1 and staff #2 acknowledged the facility did not document an analysis of the circumstances of the falls or interventions for residents? #1, #2, or #3.
Plan of Correction:	What Has Been Done to Correct? Updated Fall Analysis report and implemented Interventions as indicated for residents 1, 2, and 3 How Will Recurrence Be Prevented? Utilize Fall Analysis report post fall for all residents Person Responsible: Resident Care Director, Assistant Resident Care Director or designee