VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Oakland Manor
1830 Matoax Avenue
Petersburg, VA 23805
(804) 722-3692

Current Inspector: Yvonne Randolph (804) 662-7454

Inspection Date: Nov. 3, 2021

Complaint Related: No

Areas Reviewed:

22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS Article 1 Subjectivity

Comments:

INSPECTION SUMMARY A monitoring inspection was initiated on 11/3/2021 and concluded on 11/15/2021. The staff person in charge was contacted to initiate the inspection. the staff person in charge reported a census of five residents. The inspector emailed the staff in charge a list of items required to complete the remote documentation review portion of the inspection. The inspector reviewed two resident records, two staff records, staff schedules, staff qualifications, medication administration records and physician orders, staff training, etc. submitted by the facility to ensure documentation was complete. The inspector conducted the on-site portion of the inspection on 11/3/2021. Information gathered during the inspection determined non-compliance(s) with applicable standards or law, and violations are documented on the violation notice issued to the facility. Please secure Approval for Placement forms and Physical Examinations for residents # 2, # 3, and # 4. Forward to inspector once completed.

Violations:

Standard #:	22VAC40-73-1080-A
Description:	Based on a review of uniform assessment instruments (UAIs) for four residents, three residents admitted and retained in the safe, secure environment do not have a documented cognitive impairment due to a primary psychiatric diagnosis of dementia . Evidence: Three residents ( # 2, # 3 and # 4) were relocated to the facility from another licensed facility. Uniform Assessment Instruments reviewed did not document a primary diagnosis of dementia. Physical Examinations Reports were not available and are pending completion.
Plan of Correction:	Resident # 2, # 3, # 4 were admitted based on emergency placement. #4 was never admitted as he was hospitalized. Oakland Manor contacted referral agency to obtain UAI. Oakland Manor has issued a 30 day discharge notice. Referral agency is coordinating discharge placement ASAP. Oakland Manor will only admit individuals with a dementia/alzheimer.
Standard #:	22VAC40-73-1100-C
Description:	Based on a review of two residents files, the facility failed to document that the order of priority specified in subsection A of this section was followed for one resident. Evidence: The facility has been cited previously for failure to document that the order of priority was followed for resident # 1. The violation has not been corrected as documentation of the order of priority for resident # 1 is still not documented on the resident's Approval for Placement form. .
Plan of Correction:	Resident 1 form Order of Priority has been corrected. All parties notified and assessment updated. See attached
Standard #:	22VAC40-73-1130-A
Description:	Based on a review of the staff scheduled submitted, the facility has failed to maintain at least two direct care staff members who are awake and on duty in the special care environment. Evidence: The staff schedule for October 17, 2021 to October 31 was submitted for review. The schedule documented one staff on duty on the 7am to 7pm shift on 10/18, 10/19, 10/21, 10/22, 10/23, 10/24, 10/25, 10/26, 10/28, 10, 29, 10, 30 and 10/31. This violation was cited previously and has not been corrected.
Plan of Correction:	Team lead sent out wrong staffing schedule. Schedule has been updated to reflect staffing regulation-2 individuals at the home 24 hrs a day.