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: July 21, 2022 and July 27, 2022

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES 22VAC40-73 ADMISSION, RETENTION AND DISCHARGE OF RESIDENTS

Comments:

Type of inspection: Complaint An unannounced complaint inspection was conducted on 7-21-22 (AR 09:45 a.m./dep 1:30 p). The Acknowledgement of Inspection form was sent to the Administrator. A complaint was received by VDSS Division of Licensing on 6-6-22 regarding allegations in the area of administration and administrative services, resident care and related services. Preliminary Exit conducted on 7-27-2022. The evidence gathered during the investigation supported the allegation of non-compliance with standard(s) or law, and violation(s) were issued. Any violation(s) not related to the complaint but identified during the course of the investigation can also be found on the violation notice. 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. The final exit was conducted on 8-8-2022. 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. . For more information about the VDSS Licensing Programs, please visit: www.dss.virginia.gov Should you have any questions, please contact (Willie Barnes), Licensing Inspector at 757-439-6815 or by email at willie.barnes@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-70-A
Complaint related:	No
Description:	Based on record reviewed and staff interviewed the facility failed to report to the licensing office within 24 hours any major incident that has negatively affected or that threatens the life, health, safety, or welfare of any resident. Evidence: 1. On 7-21-22 during a complaint inspection, resident #1?s record documented incidents that were not reported to the licensing office. The facility charting notes document for resident #1 documented on 1-23-22, resident sent out via 911 due to fall and complain of right shoulder and back pain. On 2-5-22, resident was sent out via 911 after being found on the floor with blood on face and head/ update on 2-6-22 (late entry)- resident returned from ER with an eyebrow laceration. On 3-2-22, resident sent out ER following pulling out catheter, some bleeding and a lot of pain and agitation. On 3-19-22, resident sent out via 911, unwitnessed fall in dining room which resulted to abrasion to left side of head and left arm. On 4-5-22 resident sent out because of excessive bleeding from lower extremities. 2. On 7-27-22, staff #2 acknowledged resident?s incidents as noted in resident?s record.
Plan of Correction:	? ED, RSC, RSD or designee will ensure that all major incidents that negatively affect or threaten the life, safety, or welfare of all residents are reported in an effective manner with the 24 hour notification template that the community has created. The ED, RSD, RSC or designee will keep a copy of the correspondence located in the DSS Incident binder. oDate to be completed Immediately and Ongoing as of 07-27-2022
Standard #:	22VAC40-73-320-A
Complaint related:	No
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure prior to admission, the results of a risk-assessment documenting the absence of tuberculosis in a communicable form, evidenced by the completion of the current screening form published by the Virginia Department of Health or a form consistent with it. The admitting physical should include all required information. Evidence: 1. On 7-21-22 during a complaint inspection, resident #1?s record did not include documentation of the absence of tuberculosis (TB) prior to admission. Resident?s date of admission was documented as 1-9-22. 2. The admitting physical dated 1-7-22 did not include the resident?s address, telephone number, height, weight and blood pressure. 3. Staff #1 acknowledged the resident?s physical was not completed as required and the TB assessment was not in the aforementioned record.
Plan of Correction:	? ED, RSD, RSC, or designee will ensure that Virginia Department of Health forms are included and completed in entirety in the admission Health & Physical. Prior to move-in the community will have two individuals, either the ED, RSD, or RSC review the required admission paperwork via the Admission Checklist, to ensure that it is completed in entirety. Date to be completed Immediately and Ongoing as of 07-27-2022
Standard #:	22VAC40-73-325-A
Complaint related:	Yes
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure the resident?s fall risk rating shall be reviewed and updated when the condition of the resident changes and after a fall. Evidence: 1. On 7-21-22 during a complaint inspection, the resident?s record did not included documentation of a risk rating following resident?s fall documented in resident?s charting notes. The fall risk rating in the record was dated 1-9-22. The record noted falls on 1-23-22, 2-5-22, 2-6-22, 2-7-22 and 3-9-22. 2. Staff #1 acknowledged the fall risk rating was not completed for the aforementioned resident following each fall.
Plan of Correction:	? RSD, RSC, or designee will ensure that fall risk ratings are reviewed and updated when a resident has a change in condition or after a fall. Documentation of the review and any updates on the fall risk rating will be included in resident?s charts per state guidelines. o Date to be completed: Immediately and Ongoing as of 07-27-2022.