VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Hairston Home for Adults
601 Armstead Ave
Martinsville, VA 24112
(276) 638-5121

Current Inspector: Angela Marie Swink (276) 623-6575

Inspection Date: March 23, 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 22VAC40-90 THE SWORN STATEMENT OR AFFIRMATION 22VAC40-90 THE CRIMINAL HISTORY RECORD REPORT

Technical Assistance:

Licensing Inspectors had a discussion with the facility administrator and his designee to ensure understanding of various physical plant regulatory components and the facility's active improvements.

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: 03/23/2023 from 09:00 AM until 02:30 PM The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. 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 Holly Copeland, Licensing Inspector at 540-309-5982 or by email at holly.copeland@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-210-B
Description:	Based on record review, the facility failed to ensure that in a facility licensed for both residential and assisted living care, all direct care staff shall attend at least 18 hours of training annually. EVIDENCE: The record for staff 1, hired 04/26/2019, did not contain documentation of having had 18 annual training hours during staff 1?s most recent annual training period of 04/26/2021 through 04/25/2022.
Plan of Correction:	Facility will have more in-services to meet the required hours for staff.
Standard #:	22VAC40-73-350-B
Description:	Based on resident record review and staff interview, the facility failed to ascertain prior to admission whether a potential resident is a registered sex offender. EVIDENCE: 1. The record for resident 4 contained the results of a Virginia State Police sex offender registry search that was performed on 03/13/2023; however, the resident?s record indicates that she was admitted to the facility on 03/07/2023. 2. Interview with staff 4 confirmed that the sex offender registry search was not completed until after resident 4 was admitted to the facility.
Plan of Correction:	Administrator will do police checks prior to admission.
Standard #:	22VAC40-73-450-C
Description:	Based on resident record review and staff interview, the facility failed to ensure that individualized service plans (ISPs) contained all required components. EVIDENCE: 1. The public pay uniform assessment instrument (UAI) for resident 1, dated 09/14/2022, indicates that the resident requires human supervision for transferring and mobility, requires assistance with walking, and indicates that resident is incontinent of bladder weekly or more; however, these needs are not addressed on the ISP for resident 1, dated 08/30/2022. 2. The public pay UAI for resident 4, dated 02/28/2023, indicates that the resident is disoriented to some spheres, some of the time to place, time, and situation; however, the ISP for the resident, dated 03/2023, did not indicate this information. 3. Interview with staff 4 confirmed that the UAI is correct for resident 1 and resident 4 and that this information should be included on the resident?s ISP.
Plan of Correction:	Administration will add to ISP - Provide supplies for incontinence - Assist with walking and transferring Will add to ISP - Disoriented to some spheres - time to place, situation
Standard #:	22VAC40-73-450-E
Description:	Based on resident record review, the facility failed to ensure that individualized service plans (ISPs) were signed and dated by the licensee, administrator, or his designee and by the resident or his legal representative. EVIDENCE: 1. The ISP in the record for resident 1, was signed by the resident; however, the ISP does not include the date of the resident?s signature nor the signature and date of the licensee, administrator, or his designee. 2. The ISP in the record for resident 2, signed by the resident on 07/31/2022, does not include the signature and date of the licensee, administrator, or his designee. 3. The ISP in the record for resident 3, with an expected outcomes and date of expected outcomes date of 08/30/2023, does not include the signature and date of the licensee, administrator, or his designee. 4. The ISP in the record for resident 5, with an expected outcomes and date of expected outcomes date of 06/30/2023, does not include the signature and the date of the licensee, administrator, or his designee and does not include the date that the resident signed the ISP.
Plan of Correction:	Will sign all ISPs when written and reviewed.
Standard #:	22VAC40-73-610-B
Description:	Based on observation during a tour of the building, the facility failed to ensure a menu for meals and snacks for the current week was posted in an area conspicuous to residents. EVIDENCE: At approximately 09:57 AM, collateral 1 noted that the menu for meals and snacks that was posted in the facility?s dining room was not for the current week.
Plan of Correction:	Administrator will meet with kitchen staff to ensure rotation of menu is accurate.
Standard #:	22VAC40-73-860-I
Description:	Based on physical plant observation, the facility failed to store cleaning and other hazardous materials in a locked area. EVIDENCE: At approximately 09:06 AM, collateral 1 noted that the door to the small closet outside of the dining room was unlocked. Inside of the unlocked closet there was a container of floor cleaner and a container of Betco thermoplastic spray buff. This was also observed by staff 5.
Plan of Correction:	Administrator will advise staff the importance of keeping all chemicals locked in closet.