VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Bridgeforth Manor
2683 Washington Avenue Ext.
Victoria, VA 23974
(434) 696-3461

Current Inspector: Angela Rodgers-Reaves (804) 662-9774

Inspection Date: June 1, 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 ACCOMMODATIONS AND RELATED PROVISIONS 22VAC40-73 BUILDINGS AND GROUND 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 22VAC40-80 COMPLAINT INVESTIGATION 22VAC40-80 SANCTIONS

Comments:

An unannounced monitoring inspection was completed on June 01, 2022 from 12:07 p.m. to 1:58 p.m. for Bridgeforth Manor. During the entrance conference the designated staff member confirmed the census as six (6). The licensing inspector and the designated staff member completed a tour of the buildings and grounds. During the monitoring inspection the record sample consisted of six (6) resident records and three (3) staff records. Other items reviewed consist of the following: the annual health inspection, annual fire inspection, staff training, emergency food supplies, healthcare oversight, MARs review, and staff interviews. An exit meeting was conducted to review the inspection findings with the licensee / administrator. The evidence gathered during the inspection determined non-compliance with applicable standard(s) or law, and violation(s) were documented on the violation notice issued to the facility. The licensee has the opportunity to submit a plan of correction to indicate how the cited violation(s) will be addressed in order to return the facility to compliance and maintain future compliance with applicable standard(s) or law. If the licensee wishes to provide a plan of correction: (I) type the plan on a separate Word document, (ii) identify the standard violation number being addressed, (iii) include the date the violation will be corrected, (IV) do not include any names or confidential information, and (V) return to the licensing inspector by email within five (5) business days of the exit interview. Compliance with all applicable regulations and law shall be maintained and any areas of noncompliance must be corrected. Within 15 calendar days of your receipt of the inspection findings (inspection summary, violation notice, and supplemental information), you may request a review and discussion of these findings with the inspector's immediate supervisor. To make a request for review and discussion, you must contact the licensing supervisor at the regional licensing office that serves your geographical area. Regardless of whether a supervisory review has been requested, the results of the inspection will be posted to the DSS public website within 5 business days of your receipt of the Inspection Summary and/ or Violation Notice. The department's inspection findings are subject to public disclosure. Please Note: A copy of the findings of the most recent inspection are required to be posted on the premises of the facility. The inspection will be posted to the DSS public website within 5 business days of your receipt of the Inspection Summary and/ or Violation Notice. The department's inspection findings are subject to public disclosure. For more information about the VDSS Licensing Programs, please visit: www.dss.virginia.gov Should you have any questions, please contact Vashti Colson , Licensing Inspector at (804) 662-9432 or by email: vashti.colson @dss.virginia.gov

Violations:

Standard #:	22VAC40-73-320-B
Description:	VIOLATION: Based upon the record review, the facility failed to maintain an annual TB risk assessment for each resident in care. EVIDENCE: During the June 01, 2022, monitoring inspection, the most recent TB risk assessment for resident #1 was dated 11/19/19.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-870-A
Description:	VIOLATION: Based upon observation, the facility failed to maintain the interior of the building free from rubbish. EVIDENCE: During the building tour with the designated staff member, it was noted that bedroom #1 had a medium size sheet rock board laying behind the door. Also during the building tour several boxes of flooring was stacked behind the sofa in the living room.
Plan of Correction:	Not available online. Contact Inspector for more information.