VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Bickford of Virginia Beach
2629 Princess Anne Road
Virginia beach, VA 23456
(757) 821-0198

Current Inspector: Willie Barnes (757) 439-6815

Inspection Date: Oct. 4, 2022 , Oct. 27, 2022 and Nov. 18, 2022

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 ADMISSION, RETENTION AND DISCHARGE OF RESIDENTS 22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-73 RESIDENT ACCOMMODATIONS AND RELATED PROVISIONS

Comments:

Type of inspection: Complaint An unannounced complaint inspection was conducted on-site on 10-4-22 (ar 9:55 /dep 6:00) and 10-27-22 (ar 9:13/dep 5:40). The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. A complaint was received by VDSS Division of Licensing on 9-13-22 regarding allegations in the resident care. Number of residents present at the facility at the beginning of the inspection: 63 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 1 Number of staff records reviewed: 0 Number of interviews conducted with residents: Number of interviews conducted with staff: 4 Observations by licensing inspector: Additional Comments/Discussion: An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation did not support the allegation of neglect of resident care of non-compliance with standard(s) or law. However, violation(s) not related to the complaint but identified during the course of the investigation can 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 Willie Barnes, Licensing Inspector at 757-439-6815 or by email at willie .barnes@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-440-H
Complaint related:	No
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure an annual reassessment and reassessment due to a significant change in the resident?s condition, using the uniform assessment instrument (UAI), shall be utilized to determine whether a resident?s needs can continue to be met by the facility and whether continued placement in the facility is in the best interest of the resident. Evidence: 1. On 10-4-22, resident #1?s record did not have a current uniform assessment instrument (UAI). The UAI in the record was dated 8-23-21, the resident?s date of admission was documented as 11-2-19. 2. On 10-27-22, staff #1 acknowledged the record did not include a current UAI.
Plan of Correction:	*The most current UAI for resident #1 was completed on 9/7/22 and is in the medical record. *All current resident medical records will be audited to assure that the most current updated/revised resident UAI is in the medical record. *The NCC, ACC, or other identified staff member who has successfully completed UAI training, is to update/revise the UAI in conjunction with updates/revisions to the resident Service Plan. *The NCC, ACC, Dir., CRD or Designee, assisting the DSS Licensing Inspector, will be reminded to also check a resident?s thinned record if a requested form cannot be found in the medical record. *Compliance with this requirement will be monitored during scheduled Nursing Core-Check audits. Person Responsible: NCC/ACC/Dir./Designee