VIRGINIA DEPARTMENT OF SOCIAL SERVICES

The Haven Assisted Living @ Studley
7436 Studley Road
Mechanicsville, VA 23116
(804) 779-4847

Current Inspector: Kimberly Davis (804) 662-7578

Inspection Date: Jan. 25, 2022

Complaint Related: No

Areas Reviewed:

22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES 22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS Article 1 Subjectivity

Comments:

An unannounced investigation was conducted on January 25, 2022 by licensing staff and a Hanover County Sheriff?s Office Investigator to follow up on a self-report regarding a resident elopement that resulted in an injury. A census of 5 residents was reported. The identified resident?s record and facility documentation were reviewed. Staff interviews were also conducted. The violations cited are identified in this report. Please complete the "plan of correction" and "date to be corrected" for each violation cited on the violation notice and return it to the licensing office within 10 calendar days. Please specify how the violation will be corrected. The plan must contain: 1) step(s) to correct the non-compliance with the standard(s), 2) measures to prevent the non-compliance from occurring again; and 3) person(s) responsible for implementing each step and/or monitoring any preventative measure(s). Thank you for your cooperation during this inspection. I can be reached at Kimberly.M.Davis@dss.virginia.gov or (804) 662-7578.

Violations:

Standard #:	22VAC40-73-1040-B
Description:	Based on a tour of the facility the facility failed to ensure that there were protective devices on the bedroom windows of residents with serious cognitive impairments to prevent the windows from being opened wide enough for residents to crawl through. Evidence: -Licensing staff observed that the window in Room # 1 where a resident with cognitive impairment lives, did not contain a protective device to prevent it from being opened wide enough for a resident to crawl through. Photograph evidence was taken. -Staff # 3 stated that Resident # 1 had been sitting in the living room area and when she went to check on the resident in her room, Staff # 3 stated that she saw the resident?s feet going out of the window. -Facility staff stated that the handle to turn and open the window in the room where Resident # 1 lived was removed after the resident fell out of the window to prevent it from being opened. Photograph evidence was taken.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-70-A
Description:	Based on a self-report from the facility, the facility failed to notify the regional licensing office within 24 hours of any major incident that negatively affected or that threatens the life, health, safety, or welfare of any resident. Evidence: -The facility failed to notify the regional licensing office within 24 hours of an incident that occurred on 11-6-21 during which Resident # 1 fell from the window of her second-story room and was seriously injured, requiring hospitalization. -Staff # 1 emailed the licensing inspector on Friday, 11-12-21 requesting a call back to ?discuss something?. Licensing inspector emailed Staff # 1 to inform her that inspector was out at on an inspection and if the inspector was unable to return the call on Friday, 11-12-21, inspector would call Staff # 1 on Monday 11-15-21. On 11-15-21 the inspector called Staff # 1 and Staff # 1 then informed the inspector of an incident in which Resident # 1 was injured and hospitalized as a result of falling from the window on 11-6-21. -The regional licensing office was informed by an outside agency that Resident # 1 was found walking down the road from the facility on 11-2-21. The facility failed to notify the regional licensing office of the resident?s elopement. During the 1-25-22 on-site investigation, Staff # 2 informed licensing staff that she picked the resident up and brought her back to the facility.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-460-A
Description:	Based on a review of facility documentation, interviews conducted with facility staff, and information obtained from collateral contacts, the facility failed to assume general responsibility for the health, safety, and well-being of the residents. Evidence: -Staff # 3 informed licensing staff during the on-site investigation on 1-25-22 that she entered the room of Resident # 1 on 11-6-21 and saw the resident?s feet going out of the window. Staff # 3 stated that she went outside to resident and Staff # 4 called 911. Staff # 3 stated that when she went outside where the resident was laying on the ground, she observed that the resident had an open wound on her leg that was bleeding. Staff # 3 stated that she brought the resident back inside.
Plan of Correction:	Not available online. Contact Inspector for more information.