VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Golden Years Assisted Living Facility, Inc.
40 Hunt Club Boulevard
Hampton, VA 23666
(757) 825-2425

Current Inspector: Alyshia E Walker (757) 670-0504

Inspection Date: May 24, 2021

Complaint Related: No

Areas Reviewed:

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 EMERGENCY PREPAREDNESS

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 and IPOC follow-up was initiated on 05/24/2021 and concluded on 05/24/2021. The Administrator was contacted by telephone to initiate the inspection. The Administrator reported that the current census. The inspector emailed the Administrator a list of item required to complete the inspection. The inspector reviewed 3 resident records, 3 staff records, staff schedules , Fire Inspection, Health Department Inspection Report and additional documentation provided by the facility. 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 #:	22VAC40-73-440-A
Description:	Based on resident record review the facility failed to ensure the uniform assessment instrument was updated annually. Evidence: While reviewing resident record #2 the last review of the uniform assessment instrument was completed on 06/26/2020.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-450-E
Description:	Based on resident record review the facility failed to ensure the individualized service plan shall be signed and dated by the resident or his legal representative. Evidence: While reviewing resident record #3, the records individualized service plan completed 04/01/2021 was not signed by the resident or his legal representative.
Plan of Correction:	Not available online. Contact Inspector for more information.