VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Commonwealth Senior Living at King's Grant House
440 North Lynnhaven Road
Va. beach, VA 23452
(757) 431-8825

Current Inspector: Margaret T Pittman (757) 641-0984

Inspection Date: Oct. 21, 2022

Complaint Related: No

Areas Reviewed:

22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES 22VAC40-73 PERSONNEL 22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS

Comments:

Type of inspection: Monitoring Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 10/21/2022 from 9:11 am to 10:42 am. The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. A self-reported incident was received by VDSS Division of Licensing on 10/07/2022 regarding allegations in the area(s) of: Resident Care and Related Services. 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: 1 An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation supported the self-report of non-compliance with standard(s) or law, and violation(s) were issued. Any violation(s) not related to the self-report but identified during the course of the investigation can also be found on the violation notice. 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 M. Tess Pittman, Licensing Inspector at (757) 641-0984 or by email at tess.pittman@dss.virginia.gov.

Violations:

Standard #:	22VAC40-73-240-G
Description:	Based on record review, the facility to ensure all volunteers be under the supervision of a designated staff person when residents are present. Evidence: 1. During an activity on 10/06/2022, Staff #3 confirmed Volunteer #1 was alone with residents for brief amount of time.
Plan of Correction:	Reeducate Program Director and Activity Staff on Regulation 240-G ? all volunteers shall be under the supervision of designated staff member when residents are present. Reeducated all associates on Regulation 240-G. Supervision of all volunteers.
Standard #:	22VAC40-73-460-D
Description:	Based on record review and interview, the facility failed to provide supervision of resident schedules, care, and activities, including attention to specialized needs, such as wandering from the premises. Evidence: 1. On 10/06/2022, Resident #1 and Resident #2 attended an assisted living activity outside of the safe, secure environment. During the activity, Resident #1 and Resident #2 went to the restroom unattended by staff. Residents did not return to the activity and wandered to a nearby elevator. Residents took the elevator to the ground floor and exited the facility. Approximately ten minutes after leaving the activity, a spouse of another resident reported Resident #1 and Resident #2 were outside the facility. Resident #1 and Resident #2 were then redirected back into the community without incident. 2. The UAI for Resident #1 and Resident #2 (both dated 07/08/2022) indicates the residents are an elopement risk and require supervision with mobility. 3. Staff #3 confirmed the aforementioned incident to include the lack of supervision of resident activities.
Plan of Correction:	Reeducated all associates and educate all volunteers on Regulation 460-D Personal Care and General Supervision of all residents. Reeducate all staff on Regulation 460-D, General Supervision of residents. Memory Care residents will be accompanied by a staff member to the restroom while off the secure unit.