VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Greystone Manor
302 Greystone Drive
Castlewood, VA 24224
(276) 762-7929

Current Inspector: Crystal Mullins (276) 608-1067

Inspection Date: Oct. 7, 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

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: 10/07/2022 Start: 10:15am Concluded: 2:20pm 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. For more information about the VDSS Licensing Programs, please visit: www.dss.virginia.gov Should you have any questions, please contact Crystal B. Mullins, Licensing Inspector at 276-608-1067or by email at crystal.b.mullins@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-490-D
Description:	Based on review of facility records, the facility failed to ensure the healthcare oversights were met all of the requirements set forth by the standards for assisted livings. EVIDENCE: 1. Healthcare oversights were completed on 03/01/2022, 06/01/2022, and 09/01/2022. The health care professional completing these healthcare oversights did not sign the documented oversight.
Plan of Correction:	In the future, administrator will ensure oversights are signed upon completion. [sic]
Standard #:	22VAC40-73-700-2
Description:	Based on observations made during the tour of the building, the facility failed to post ?No Smoking-Oxygen in Use? signs in rooms where oxygen is in use. EVIDENCE: 1. Room #2 and #17 had a resident using oxygen, there was not a ?No Smoking-Oxygen in Use? sign posted on this door.
Plan of Correction:	In the future, when a resident is prescribed oxygen, a sign will be posted on his/her room door as opposed to just on entrance doors to the facility. [sic]
Standard #:	22VAC40-73-750-B
Description:	Based on observations made during the tour of the building, the facility failed to have all required items in each resident room. EVIDNCE: 1. Room #13 only had one chair available in the room but there were two residents.
Plan of Correction:	In the future, residents wishing to remove required furniture will have a signed note in his/her chart noting which items he/she wishes to remove. [sic]
Standard #:	22VAC40-73-750-E
Description:	Based on observations made during the tour of the building, the facility failed to have sufficient linens in good repair and always available for residents. EVIDNCE: 1. Room #13 and #8 did not have a sheet on the bed located to the left. 2. Room #9 did not have a sheet on the bed located to the right. 3. Room #10 and #4 did not have sheets on either bed.
Plan of Correction:	Housekeeping and other staff will continue to ask residents to keep sheets on beds and to not remove the sheet straps designed to hold sheets on the mattress. [sic]
Standard #:	22VAC40-73-870-A
Description:	Based on observations made during the tour of the building, the facility failed to maintain the interior and exterior of the building in good repair and clean. EVIDENCE: 1. Room #2 had what appeared to be loose tobacco scattered about the floor of the room. There were also large black spots on the floor that looked like a liquid had been spilled and dried. 2. Room #9 had large dark colored spots on the floor, as if a liquid had dried and not been cleaned up. 3. The upstairs hallway near Rooms #10, #7, #11, and #9 was found to have particles of popcorn scattered about. 4. Room #4 was cluttered and was found to have loose tobacco particles scattered about the floor. The left side of Room #4 was observed to have potato chip pieces in the floor beside the trashcan and under the bed. The floor had the appearance of dark substances which had dried and not been mopped. 5. Room #13 was observed to have clumps of tobacco on the top of the bed linens and brown liquid (appeared to be tobacco spit) dried on the floor.
Plan of Correction:	In the future, housekeeping will make extra rounds to rooms with tobacco users. Residents will be reminded tobacco use is only permitted outside the building. Housekeeping will monitor rooms hourly for spills and special snacks (i.e. popcorn) that may have been taken to rooms. [sic]
Standard #:	22VAC40-73-870-B
Description:	Based on observations made during the tour of the building, the facility failed to keep all areas free from foul odors. EVIDENCE: 1. Room #13 had a strong urine odor.
Plan of Correction:	Housekeeping will continue to monitor this room hourly and staff will continue to advise resident they must use the restroom, not their room. [sic]
Standard #:	22VAC40-73-920-C
Description:	Based on observations made during the tour of the building, the facility failed to have ventilation to the outside in order to eliminate foul odors in the bathroom. EVIDENCE: 1. The men?s common bathroom across from Room #15 had a vent that was inoperable. 2. The men?s common bathroom upstairs across from the medication room had a vent fan that was inoperable.
Plan of Correction:	In the future, maintenance will ensure all ventilation fans are working properly on a weekly basis. [sic]