VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Clara's Residential Assisted Living
1638 W. Grace Street
Richmond, VA 23220
(804) 353-6573

Current Inspector: Coy Stevenson (804) 972-4700

Inspection Date: Sept. 21, 2022

Complaint Related: No

Areas Reviewed:

22VAC40-73 GENERAL PROVISIONS 22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES 22VAC40-73 PERSONNEL 22VAC40-73 STAFFING AND SUPERVISION X 22VAC40-73 ADMISSION, RETENTION AND DISCHARGE OF RESIDENTS X 22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-73 RESIDENT ACCOMMODATIONS AND RELATED PROVISIONS X 22VAC40-73 BUILDINGS AND GROUND 22VAC40-73 EMERGENCY PREPAREDNESS 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS ARTICLE 1 ? SUBJECTIVITY 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 22VAC40-80 COMPLAINT INVESTIGATION 22VAC40-80 SANCTIONS

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: 9-21-2022, 8 ? 10:30 am and 2:45 ? 3:15 pm 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: 14 Number of resident records reviewed: 6 Number of staff records reviewed: 4 Number of interviews conducted with staff: 3 Observations by licensing inspector: Meal, Medication Administration, Tour, Water Temperatures, Emergency Food and Water, Records 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 Alexandra Poulter, Licensing Inspector at (804)662-9771 or by email at alex.poulter@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-320-A
Description:	Based on record review and interview with staff, the facility failed to ensure within the 30 days preceding admission, a person shall have a physical examination by an independent physician. The report of such examination shall be on file at the assisted living facility. Evidence: 1. The following resident records did not contain a physical examination within 30 days preceding admission and instead had physical examinations with the following dates: A. Resident #3: Admitted 12-27-2021; examination on 8-24-2022; and B. Resident #6: Admitted 12-27-2021; examination on 5-11-2021. 2. Staff #1 confirmed during interview that the aforementioned physical examinations in the record were not within 30 days preceding admission. Staff #1 and Staff #4 stated that they have been purging the initial admission physical examination and not keeping them in the residents? records.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-450-C
Description:	Based on record review, the facility failed to ensure the comprehensive individualized service plan (ISP) included a description of identified needs based on the UAI. Evidence: 1. Resident #3 admitted 12-27-2021. Resident #3?s UAI dated 5-20-2022 documented resident #3 had a guardian as well as his admitting paperwork; however, this need was not identified on the resident?s ISP dated 12-27-2021. 2. Staff #4 acknowledged the ISP did not contain the information on Resident #3?s guardian per the UAI during interview.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-450-F
Description:	Based on record review and interview with staff, the facility failed to ensure individualized service plans (ISPs) shall be reviewed and updated at least once every 12 months and as needed for a significant change of a resident?s condition. Evidence: 1. Resident #2 admitted 11-26-2018. Resident #2?s UAI dated 11-23-2021 documented the resident requires assistance with meal preparation; however, this service was not identified on the resident?s comprehensive ISP dated 11-26-2021. 2. Staff #4 acknowledged Resident #2?s ISP did not identify meal preparation as per the resident?s UAI.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-550-G
Description:	Based on record review and interview with staff, the rights and responsibilities of residents in assisted living facilities shall be reviewed annually with each resident or his legal representative or responsible individual and evidence of this review shall be the resident's, his legal representative's responsible individual's, which shall include the date of the review and shall be filed in the resident's or staff person's record. Evidence: 1. Resident #1 admitted 4-10-2017. Resident #1?s most current annual rights was signed 1-01-2021. 2. Staff #4 acknowledged the most current annual rights for Resident #1 were not completed.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-650-E
Description:	Based on record review and interview with staff, the facility failed to ensure the resident's record contained the physician's or other prescriber's signed written order or a dated notation of the physician's or other prescriber's oral order. Evidence: 1. The following medications were administered to the residents on the date of inspection without a copy of the signed written order for the medications: A. Resident #1: Lithium Carb 300 mg, B. Resident #3: Metformin 500 mg, and C. Resident #7: Mirtazapine 30 mg. 2. Staff #2 confirmed the signed physician?s orders for the aforementioned residents? medications were not at the facility.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-860-G
Description:	Based on observation and interview with staff, the facility failed to ensure hot water at taps available to residents was maintained within a range of 105?F to 120?F. Evidence: 1. During tour of the facility, the following two temperatures were obtained at two taps available to residents: A. Downstairs shared bathroom ? 125.5?F; B. Upstairs shared bathroom ? 129?F. 2. Staff #1 was present during the tour and observed the water temperatures not within the required range.
Plan of Correction:	Not available online. Contact Inspector for more information.