VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Harmony at Independence
2077 South Independence Boulevard
Virginia beach, VA 23453
(757) 802-3665

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

Inspection Date: July 6, 2021 and July 8, 2021

Complaint Related: No

Areas Reviewed:

A renewal inspection was initiated on 7/1/21 and concluded on 7/8/21. The Administrator was contacted by telephone to initiate the inspection. The Administrator reported that the current census was 86. The inspector emailed the Administrator a list of items required to complete the remote documentation review portion of the inspection. The inspector reviewed 4 resident records, 4 staff records, menu, activities calendar, and staff schedules submitted by the facility to ensure documentation was complete. The inspector conducted the on-site portion of the inspection on 7/2/21. An exit interview with the Administrator on the date of the inspection, where findings were reviewed and an opportunity was given for questions, as well as for providing any information or documentation which was not available during the inspection. Information gathered during the inspection determined non-compliances with applicable standards or law, and violations were documented on the violation notice issued to the facility.

Violations:

Standard #:	22VAC40-73-440-B
Description:	Based on record review and discussion the facility failed to ensure the administrator approves and signs the completed Uniform Assessment Instrument. Evidence: 1. Resident #3?s Uniform Assessment Instrument (UAI) dated 12/15/20 was completed by a staff member at the facility. 2. Resident #3?s UAI dated 12/15/20 did not have the assessor?s signature nor was it signed and dated by the Administrator. 3. Staff #5 acknowledged that Resident #3?s UAI dated 12/15/20 did not contain the assessor?s signature nor was it signed and dated by the Administrator.
Plan of Correction:	Resident #3's UAI has been reviewed and signed by the Healthcare Director and the Administrator. The Executive Director will audit 5% of all UAI's to ensure they have been reviewed and signed. Person responsible: Brenda Stevenson and Shawn Buckon
Standard #:	22VAC40-73-450-E
Description:	Based on record review and discussion the facility failed to ensure the individualized service plan was signed and dated by the licensee, administrator, or his designee, and by the resident or his legal representative. Evidence: 1. Resident #3?s Individualized Service Plan (ISP) dated 2/1/21 was provided by the facility. 2. Resident #3?s ISP was not signed and dated by the licensee, administrator, or his designee, nor the resident or his legal representative. 3. Staff #5 acknowledged that Resident #3?s ISP dated 2/1/21 was not signed and dated by the licensee, administrator, or his designee, nor the resident or his legal representative.
Plan of Correction:	Resident #3's ISP has been corrected and signed by the Healthcare Director and the Administrator. The Executive Director will audit 5% of all ISP's to ensure the resident, responsible party, Administrator and all participants of the ISP have reviewed and signed. Person Responsible: Brenda Stevenson and Shawn Buckon