VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Harper's Station at Gainesville
15951 Loves Mill Lane
Gainesville, VA 20155
(703) 270-0284

Current Inspector: Sarah Pearson (540) 680-9469

Inspection Date: Nov. 30, 2022

Complaint Related: No

Areas Reviewed:

Administration and Administrative Services Personnel Staffing and Supervision Admission, Retention and Discharge of Residents Resident Care and Related Services Resident Accommodations and Related Provisions Building and Ground Emergency Preparedness Additional Requirements for Facilities that Care for Adults with Serious Cognitive Impairments

Comments:

Date of Inspection: November 30, 2022 9:32am-2:30pm Type of Inspection: Renewal inspection If you have any questions or email changes, please do not hesitate to contact me at sarah.pearson@dss.virginia.gov. If you need a copy of any of the DSS Model forms or to review any inspection or regulation, you can find the information on the internet: www.dss.virginia.gov. Census 19 Number of records reviewed and interviews conducted- 7 records, 5 interviews. All facility self-reported incidents since the last inspection were reviewed on this date. The Licensing Inspector and the Administrator discussed the risk assessment ratings for the violations for this inspection. Please complete the ?plan of correction? and ?date to be corrected? for each violation cited on the violation notice and returned it to the office. You will need to specify how the deficient practice will be or has been corrected. Your plan of correction must contain: 1) steps to correct the noncompliance with the standard(s), 2) measures to prevent the noncompliance from occurring again; and 3) person(s) responsible for implementing each step and/or monitoring any preventive measure(s). The completed corrective action needs to be in the licensing office by December 9, 2022

Violations:

Standard #:	22VAC40-73-450-B
Description:	Based on resident record review and staff interview, it was determined that the facility failed to develop an Individualized Service Plan that supported the principle of individuality for Res B.
Plan of Correction:	Harper's Station corporate office (SRI) has removed its policy for use of its Personalized Service Plan (PSP) at Harper's Station. The administrator and designee who have completed VDSS approved ISP training, will adhere to developing comprehensive Individualized Service Plan (ISP) to meet resident's service needs effective immediately. The administrator or designee will monitor for the next 90 days and follow up that licensed health care professional, practicing within their scope, have had VDSS approved training of ISPs and that the licensed health care professionals develop ISPs specific to resident care needs.