VIRGINIA DEPARTMENT OF SOCIAL SERVICES

The Haven Assisted Living @ Sandy Valley
4350 Sandy Valley Road
Mechanicsville, VA 23111
(804) 779-3154

Current Inspector: Shelby Haskins (804) 305-4876

Inspection Date: Sept. 9, 2022

Complaint Related: No

Comments:

Type of inspection: Renewal Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 09/09/2022 beginning at approximate times of 9:48a.m until 10:52a.m and on 09/14/2022 approximate times 11:50 a.m. until 12:40p.m The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. Number of residents present at the facility at the beginning of the inspection: 5 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. 09/09/2022 Number of resident records reviewed: 2 Number of staff records reviewed: 2 Number of interviews conducted with residents: 2 Number of interviews conducted with staff: 2 Observations by licensing inspector: Observation of medication administration conducted on 09/14/2022 Additional Comments/Discussion: Noncompliance to be cited discussed with facility Manager on 09/09, 14/2022. An exit meeting will be conducted to review the inspection findings. 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. For more information about the VDSS Licensing Programs, please visit: www.dss.virginia.gov Should you have any questions, please contact Angela Rodgers-Reaves, Licensing Inspector at (804) 840-0252 or by email at angela.r.reaves@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-870-A
Description:	Based on observation the facility failed to ensure that the exterior of the building is maintained in good repair. Evidence: As evidenced by the photographs taken on 09/09, 14/2022, the metal in a section of the column on the front porch was detached. On both days the inspector pointed out the area being referenced to the facility?s manager.
Plan of Correction:	FACILITY'S RESPONSE: "Maintenance will perform preventive maintenance to maintain facility in good repair."