VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Commonwealth Senior Living at Hillsville
100 Kyle Drive
Hillsville, VA 24343
(276) 728-5333

Current Inspector: Crystal Mullins (276) 608-1067

Inspection Date: Oct. 5, 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

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: 10/5/2022 start: 9:30am-3:00pm The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. 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.

Violations:

Standard #:	22VAC40-73-320-A
Description:	Based on resident record review, the facility failed to have the physical examination within 30 days preceding admission completed to include all information required by standards. EVIDENCE: 1. Resident #2 has a physical signed by a physician on 05/05/2022. The physical included allergies listed as beestings. There was no reactions listed for this allergy.
Plan of Correction:	Resident?s PCP contact to clarify reaction to allergy. Physician order sheet updated to reflect reaction to allergies. RCD and/or Designee will ensure reactions to allergies are captured. RCD or Designee 10.6.2022 [sic]
Standard #:	22VAC40-73-380-A
Description:	Based on resident record review, the facility failed to complete all items on the persona and social information sheet for two residents. EVIDENCE: 1. Resident #1 was admitted to the facility on 12/17/2021. The personal and social information was found to have the next of kin #2 blank and on page 2 the current behaviors and social function; the strengths and problems were left blank. 2. Resident # 9 was admitted to the facility on 07/02/2018. The local department of social services was left blank on the personal and social information sheet.
Plan of Correction:	Resident Personal Social Data updated to reflect needed information. ED or Designee will audit Personal/Social Data sheets to ensure they are completed prior to admission. ED or Designee 10.6.2022 [sic]
Standard #:	22VAC40-73-450-C
Description:	Based on observations of resident records, the facility failed to include all identified needs based upon the Uniform Assessment Instrument (UAI). EVIDENCE: 1. Resident # 1's UAI is dated 06/30/2022 and the Individualized Service Plan (ISP) is dated for 07/11/2022. On the UAI for Resident #1 the phsycho/social section states that Resident #1 has displayed wandering as a type of inappropriate behavior; but this is not addressed as an identified need on the ISP for Resident #1. 2. According to Staff #17, Resident #1 does wander less than once weekly and stated the box should be selected on the UAI and should be listed as a need on the ISP.
Plan of Correction:	Resident?s UAI and ISP was updated to reflect the correct information. RCD and/or Designee will ensure all UAI and ISP information matches going forward. RCD or Designee 10.6.2022 [sic]