VIRGINIA DEPARTMENT OF SOCIAL SERVICES

The Haven Assisted Living @ Studley
7436 Studley Road
Mechanicsville, VA 23116
(804) 779-4847

Current Inspector: Kimberly Davis (804) 662-7578

Inspection Date: Oct. 11, 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 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:

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: October 11, 2022 from 9:25 a.m.-12:25 p.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: 7 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 4 Number of staff records reviewed: 3 Additional Comments/Discussion: The following items were reviewed/observed during the inspection: facility documentation, facility postings, tour of the facility, first aid kit, emergency food supplies, medication pass/physician?s orders/medication administration records (MARs). An exit meeting was 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 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 Kimberly Davis, Licensing Inspector at (804) 662-7578 or by email at Kimberly.M.Davis@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-1040-A
Description:	Based on observation the facility failed to ensure that doors leading to the outside shall have a system of security monitoring of residents with serious cognitive impairments. Such as door alarms, cameras, constant staff oversight, security bracelets that are part of an alarm system, or delayed egress mechanisms. Evidence: -Staff # 5 stated that there are three residents at the facility with serious cognitive impairment, however, the door alarm on the side door did not sound when the licensing inspector unlocked and opened the door to check the alarm functionality on two attempts with Staff # 5 observing. -Staff # 5 pressed the alarm button above the door and it made alert sounds afterwards.
Plan of Correction:	Administrator will ensure batteries are replaced and maintenance will ensure proper function of alarms. Staff will also ensure alarms are kept on at all times.
Standard #:	22VAC40-73-440-A
Description:	Based on a review of resident records the facility failed to ensure that the Uniform Assessment Instrument (UAI) shall be completed at least annually, or whenever there is a significant change in the resident?s condition. Evidence: -The record for Resident # 1 (admit date: 8-31-21) contained a UAI last dated 9-30-21. -Staff # 4 stated she did not realize the UAI had not been updated.
Plan of Correction:	Administrator will ensure new UAI is placed and completed and updated in a timely manner.
Standard #:	22VAC40-73-870-A
Description:	Based on observation the facility failed to ensure that the exterior of the building was maintained in good repair. Evidence: -The doorbell at the side door entrance was detached and did not work. Photographic evidence was taken. -Staff # 4 stated that they would have maintenance repair the doorbell.
Plan of Correction:	Maintenance will ensure proper function of the exteriors of building and grounds.
Standard #:	22VAC40-73-980-A
Description:	Based on a review of the facility?s first aid kit the facility failed to ensure that the first aid kit contained all required items. Evidence: -The first aid kit did not contain adhesive tape, antiseptic ointment, hand cleaner (sanitizer), scissors, or a small flashlight. -Staff # 4 stated that she would order the first aid kit supplies.
Plan of Correction:	Administrator will ensure first aid kit supplies are replaced in a timely manner when supplies are used. Replacement supplies to be ordered on site and corrected by administrator.
Standard #:	22VAC40-73-980-H
Description:	Based on observation the facility failed to ensure that it had at least a 48 hour supply of emergency drinking water on site. Evidence: -The facility did not have a supply of emergency drinking water on site. -Staff # 5 stated that the facility ?switched the big blue water jugs out and they are not here now.?
Plan of Correction:	Administrator will ensure water is rotated and replaced on site same day it is rotated.