VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Commonwealth Memory Care at Chesapeake
130 Great Bridge Boulevard
Chesapeake, VA 23320
(757) 436-2109

Current Inspector: Donesia Peoples (757) 353-0430

Inspection Date: March 10, 2022 and March 25, 2022

Complaint Related: No

Areas Reviewed:

22VAC40-73 STAFFING AND SUPERVISION 22VAC40-73 ADMISSION, RETENTION, AND DISCHARGE OF RESIDENTS 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS Article 1 Subjectivity

Comments:

An unannounced monitoring inspection was conducted on 3-10-22. The facility census was 50. An Exit meeting was conducted with the Administrator and the Acknowledgement Form was emailed. Please complete the columns for "description of action to be taken" and "date to be corrected" for each violation cited on the violation notice, and then return a signed and dated copy to the licensing office within 10 calendar days of receipt. You need to be specific with how the deficiencies either have been or will be corrected to bring you into compliance with the Standards. Your plan of correction must contain the following three points: 1. Steps to correct the noncompliance with the standard(s) 2. Measures to prevent the noncompliance from occurring again 3. Person(s) responsible for implementing each step and/or monitoring any preventive measure(s) Please provide your responses in a Word Document, if possible. POC due within 10 days: 4-11-22

Violations:

Standard #:	22VAC40-73-1180-B
Description:	Based on record review and staff interview, the facility failed to ensue when there are indications that ordinary material or objects may be harmful to a resident, these materials or objects shall be inaccessible to the resident except under the staff supervision. Evidence 1. On 11-7-21 an incident report was received documenting, ?resident observed taking housekeeper?s handheld hand sanitizer and drinking a small amount?. 2. Resident?s uniformed assessment instrument (UAI) dated 5-10-21 documented resident wanders. The individualized service plan (ISP) dated 6-9-21 was not updated to address resident?s two occasions of ingestion of foreign substance, 6-24-21 and 11-7-21 and what staff services were put in place to address resident?s safety concerns. 3. On 3-25-22, staff #1 acknowledged resident?s ISP was not updated to address the resident accessing harmful objects on the safe, secure unit.
Plan of Correction:	Assistant Resident Director and Executive Director updated UAI to reflect residents' behavior, and ISP updated to reflect interventions to prevent resident from ingesting foreign objects. Staff in serviced on interventions to prevent all residents from ingesting foreign objects. April 15, 2022 and ongoing