VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Chesapeake Place
1500 & 1508 Volvo Parkway
Chesapeake, VA 23320
(757) 548-0808

Current Inspector: Donesia Peoples (757) 353-0430

Inspection Date: Feb. 11, 2022 , March 3, 2022 and March 17, 2022

Complaint Related: No

Areas Reviewed:

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 BUILDING AND GROUNDS 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

Comments:

An unannounced monitoring- IPOC inspection was conducted on 2-11-22 (ar 06:45 a.m./dep 3:00 p.m). The facility census was 73. Resident and staff records were reviewed, background checks reviewed, medication pass observed, breakfast meal on safe, secure unit and assisted living units observed. An exit meeting was conducted with the administrator. The acknowledgement form was sent electronically. 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.

Violations:

Standard #:	22VAC40-73-450-F
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure the individualized service plan (ISP) was updated as needed for a significant change of a resident?s condition. Evidence: 1. Resident #5?s record documented Speech therapy, 2-15-21 through 3-16-21; Occupational therapy 3-3-21 through 4-1-21; 12-10-21 through 1-8-11; 2-4-22 through 3-5-22; Physical therapy, evaluation of left hand contracture, 8-27-21, 12-1-21 through 12-30-21; 2-15-21 through 3-16-21. These services were not documented on resident?s ISP dated 11-17-21. 2. On 2-11-21, staff #2 acknowledged services were not on resident?s ISP.
Plan of Correction:	Resident Care Director reviewed ISP and added therapy notes to ISP. ED & RCD will add therapy notes upon receipt to ensure timely recording of progress of services