VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Care Corner Senior Care
224 Fishersville Road
Fishersville, VA 22939
(540) 949-8546

Current Inspector: Jessica Gale (540) 571-0358

Inspection Date: Jan. 13, 2023

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 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

Technical Assistance:

1.Need to update agreement to include requirements from the auxiliary grant now that in admitting grant recipients. 2.Addendums need to be added to agreements as it relates to rate increases. 3.Staff registered for serve safe class as per health department recommendation on January 30th.

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: 1/10,12,13/2023 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: 26 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Note related violation. Number of resident records reviewed: 5 Number of staff records reviewed: 7 Number of interviews conducted with residents: 4 Number of interviews conducted with staff: 4 Observations by licensing inspector: Outside inspections were current. Fourth quarter fire drills had not been completed but all emergency drills had been documented. The facility has a contract for a portable generator in the event of a power loss and emergency lighting is available in the facility. Additional Comments/Discussion: Refer technical assistance An exit meeting will be conducted to review the inspection findings. A meeting was held on 1/13/2023 with the new administrator and owner of the facility. 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. Should you have any questions, please contact Sharon DeBoever, Licensing Inspector at (540) 292-5930 or by email at sharon.deboever@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-120-A
Description:	Based on a review of staff records orientation and initial training was not documented as completed within the first seven working days of employment for staff A, B, C or D. Staff interviewed were aware, however, of job duties and emergency procedures.
Plan of Correction:	The owner, who is a licensed administrator, will review with the new administrator documentation requirements related to staff records as a whole. The administrator assumes responsibility for correction and future compliance.
Standard #:	22VAC40-73-560-E
Description:	Based on a review of a sampling of resident records, the information maintained in the records is not kept current. In some cases, the information did not exist. Resident A: Property inventory was blank; no sex offender status form. Resident B: No fall risk assessment, mental health screening, sex offender status, individualized service plan and UAI was past due (9/15/21 last update) Resident C: No sex offender status; service plan had no signatures or indication of review with resident Resident D: Both the service plan and UAI are out of date Resident E: Service plan is out of date (This violation incorporates standards 440 and 450 as they relate to uniform assessment and individualized service plans and 350) Residents interviewed did not voice any concerns or complaints regarding related service needs.
Plan of Correction:	All records will be reviewed, and a checklist developed for what each record should contain. The owner, who is a licensed administrator, will work with the new administrator in regard to training what is required in the resident record and related standards. A spreadsheet will be developed to indicate due dates for service plans and assessments and related annual items required in residential living. The owner along with the administrator assume responsibility for correction and future compliance.
Standard #:	22VAC40-73-870-A
Description:	Based on observation during a walk through of the building the corner of the ceiling in the medication room needs replacement due to water damage and the areas related to that damage. Repairs were identified in other parts of the building as being completed.
Plan of Correction:	The facility has applied for a grant to address those areas. In the interim a pipe froze in another area and all resources were directed at that to get heat returned to the building as quickly as possible. The owner assumes responsibility for correction and continued compliance in this area.
Standard #:	22VAC40-73-970-A
Description:	Fire drills for the fourth quarter (October -December) were not completed.
Plan of Correction:	The administrator assumes responsibility for correction and compliance. A calendar is being developed to include both fire and emergency drill requirements.