VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Holly Manor AL IL Operations LLC
2005 Cobb Street
Farmville, VA 23901
(434) 392-6106

Current Inspector: Kimberly Davis (804) 662-7578

Inspection Date: April 25, 2022

Complaint Related: No

Areas Reviewed:

22VAC40-73 GENERAL PROVISIONS 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 32.1 Reported by persons other than physicians 63.2 General Provisions. 63.2 Protection of adults and reporting. 63.2 Licensure and Registration Procedures 63.2 Facilities and Programs.. 22VAC40-90 Background Checks for Assisted Living Facilities 22VAC40-90 The Sworn Statement or Affirmation 22VAC40-90 The Criminal History Record Report 22VAC40-80 THE LICENSE. 22VAC40-80 THE LICENSING PROCESS.

Comments:

An announced initial inspection was conducted on April 25, 2022, from 1:459 p.m. to 5:09 p.m. At the time of entrance, the facility's infection control monitoring policy was actively implemented for all visitors, staff members, and residents. During the entrance conference, the administration team reported the census as fifty six (56) residents in care. Residents were observed during daily activities and direct care staff members were observed providing resident centered services. The record sample size consisted of five (5) resident records and five (5) new staff records. The licensing representative and the designated staff member toured the build and observed the following: residents engaged in daily activities, meal observations, emergency food supplies, training documents, common areas, bedrooms, and maintenance/housekeeping records. Also during the initial inspection, interviews were conducted with several staff members and residents. Information gathered during the inspection determined compliance with the applicable standards or laws and no violations were cited. You can contact the assigned inspector at (804) 662-9432 or send an email to Vashti. Colson @dss.virginia.gov to discuss any questions you may have. Thank you for your cooperation.