VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Oakland Manor
1830 Matoax Avenue
Petersburg, VA 23805
(804) 722-3692

Current Inspector: Yvonne Randolph (804) 662-7454

Inspection Date: Oct. 24, 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

Technical Assistance:

Staff Person In Charge posting Reviewing service plan and rights with residents who have a cognitive impairment

Comments:

Type of inspection: Renewal Date of inspection and time the licensing inspector was on-site at the facility for day of the inspection:10/24/22, 11:30 am -1:00 pm The Acknowledgement of Inspection form was signed and emailed to the facility on the date of the inspection. Number of residents present at the facility at the beginning of the inspection: 1 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 2 Number of staff records reviewed: 2 Number of interviews conducted with residents: Resident is non-verbal Number of interviews conducted with staff: 2 Observations by licensing inspector: Medication administration, postings, building and grounds Additional Comments/Discussion: A renewal of license inspection was conducted. 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 Yvonne Randolph, Licensing Inspector at (804) 441-1180 or by email at yvonne.randolph@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-250-D
Description:	Based on a review of two staff files, the results of an initial risk assessment, documenting the absence of tuberculosis in a communicable form, was not obtained for one staff on or within seven days prior to the first day of work at the facility. Evidence: A file review found a documented start date of employment for staff # 2 of 1/31/22. The risk assessment on file was dated 9/6/22.
Plan of Correction:	The administrator will ensure that all employees have a TB (current) prior to employment or within 7 days of employment. The administrator will audit employee file folders quarterly to ensure employees have current TB.
Standard #:	22VAC40-73-290-A
Description:	Based on an observation at the facility and interview with staff on 10-24-22, the facility has not developed and implemented a procedure for posting the name of the current on-site person in charge. Evidence: A posting of the on-site person in charge was not observed on the date of the inspection.
Plan of Correction:	The facility has posted the onsite person in charge. The posting was placed on the bulletin board on 10-26-23.
Standard #:	22VAC40-73-450-C
Description:	Based on a review of two resident files, the individualized service plan for one resident was not signed or dated by the resident?s responsible party. Evidence: A file review found no documentation to support that the service plan for resident # 1 had been reviewed, signed or dated by the resident?s responsible party.
Plan of Correction:	Resident unable to sign due to cognitive impairment. Sister has been notified of this issue and will sign on behalf of the resident. Staff emailed documents on 10/25/23 to sister.