VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Brookdale Harrisonburg
2101 Deyerle Avenue
Harrisonburg, VA 22801
(540) 574-2982

Current Inspector: Jessica Gale (540) 571-0358

Inspection Date: March 31, 2022

Complaint Related: No

Areas Reviewed:

22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES 22VAC40-73 PERSONNEL 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 BUILDING AND GROUNDS 22VAC40-73 EMERGENCY PREPAREDNESS 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS Article 1 Subjectivity 22VAC40-90 Background Checks for Assisted Living Facilities 22VAC40-90 The Sworn Statement or Affirmation 22VAC40-90 The Criminal History Record Report

Technical Assistance:

Discussion occurred with the ED on the following topics: 1. Ensure the Social Data sheet is completed 2. Describe resident behaviors on the ISP

Comments:

A mandated monitoring inspection was conducted by two LIs on 03/31/2022. there were 51residents in care. A walk through was completed and the facility was clean and free from any foul odors. The menu and activities calendar were reviewed in addition to outside inspections and fire drills. Five resident and four staff records were reviewed. There were four violations during this monitoring inspection. Details of non-compliance can be viewed on the violation notice section of this report. If you have any questions, please contact the licensing inspector at (540) 292-5932 or email rhonda.whitmer@dss.virginia.gov.

Violations:

Standard #:	22VAC40-73-320-A
Description:	Based on a review of residents' records, the facility failed to ensure a physical examination was completed within 30 days of admission. EVIDENCE: 1. Resident 1 was admitted to the facility on 03/21/2022. The physical examination report is dated 02/14/2022.
Plan of Correction:	The ED will educate the Sales Manager, Health and Wellness Director, Health and Wellness Coordinator and Resident Care Coordinator on the Physical Examination Requirements.
Standard #:	22VAC40-73-440-A
Description:	Based on review of residents' records, the facility failed to ensure the Uniform Assessment Instrument is completed annually as required. EVIDENCE: 1. The UAI on file for resident 3 is dated 03/22/2021.
Plan of Correction:	The ED will educate the Health and Wellness Director, Health and Wellness Coordinator and Resident Care Coordinator on UAI Requirements. The ED, Health and Wellness Director, Health and Wellness Coordinator or Resident Care Coordinator will audit and update all resident UAIs by 6/30/2022.
Standard #:	22VAC40-73-450-C
Description:	Based on review of residents' records, the facility failed to ensure the Individualized Service Plan (ISP) included all required components. EVIDENCE: 1. The Uniform Assessment Instrument (UAI) for resident 1 dated 03/21/2022 indicates physical and mechanical assistance is needed with dressing. The ISP indicates only physical assistance is needed . 2. The UAI for resident 1 dated 03/21/2022 indicates stairclimbing is not performed. The ISP dated 03/21/2022 indicates mechanical and physical assistance is needed with stairclimbing. 3. The UAI for resident 2 dated 03/29/2022 indicates physical assistance is needed with dressing. The ISP dated 03/30/2022 indicates mechanical and physical assistance is needed. 4. The file for resident 4 admitted 12/10/2021 does not include a comprehensive ISP.
Plan of Correction:	The ED will educate the Health and Wellness Director, Health and Wellness Coordinator and Resident Care Coordinator on UAI and ISP Requirements. The ED, Health and Wellness Director, Health and Wellness Coordinator or Resident Care Coordinator will audit and update all resident UAIs and ISPs by 6/30/2022 making sure that resident needs are addressed, accurate and match on both the UAI and ISPs.
Standard #:	22VAC40-73-450-F
Description:	Based on review of residents' records, the facility failed to ensure the Individualized Service Plan (ISP) is reviewed and updated annually. EVIDENCE: The ISP for resident 3 is dated 03/22/2021.
Plan of Correction:	The ED will educate the Health and Wellness Director, Health and Wellness Coordinator and Resident Care Coordinator on ISP Requirements. The ED, Health and Wellness Director, Health and Wellness Coordinator or Resident Care Coordinator will audit and update all resident ISPs by 6/30/2022.