VIRGINIA DEPARTMENT OF SOCIAL SERVICES

The Haven Assisted Living @ Studley
7436 Studley Road
Mechanicsville, VA 23116
(804) 779-4847

Current Inspector: Kimberly Davis (804) 662-7578

Inspection Date: March 17, 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 22VAC40-73 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

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: 3-17-23 from 10:10 a.m.- 12:40 p.m. 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: 7 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 4 Number of staff records reviewed: 3 Number of interviews conducted with residents: 2 Number of interviews conducted with staff: 2 Additional Comments/Discussion: The following items were also reviewed/observed: facility postings, facility documentation, first aid kit, lunch meal/menu, emergency food and water, medication pass, physician?s orders, and Medication Administration Records (MARs). Residents and staff were also interviewed. An exit meeting was 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 Kimberly Davis, Licensing Inspector at (804) 662-7578 or by email at Kimberly.M.Davis@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-1040-A
Description:	Based on observation the facility failed to ensure that doors leading to the outside shall have a system of security monitoring of residents with serious cognitive impairments, such as door alarms, cameras, constant staff oversight, security bracelets that are part of an alarm system, or delayed egress mechanisms. Evidence: -The facility?s census includes four residents with serious cognitive impairment. -The side door was locked from the inside with a deadbolt lock which is a safety concern in the event of a fire. Staff # 1 unlocked the door with a key. When the licensing inspector opened the door, it was determined that the door alarm was not working and had not been replaced which was previously cited during the 3-3-23 inspection. The facility failed to repair the door alarm by 3-5-23 as stated in their plan of correction. -The licensing inspector opened the front door which contained an alarm, but the alarm did not sound. Staff # 1 confirmed that the front door alarm was not working. This was also cited during the 3-3-23 inspection. The facility failed to replace the alarm by 3-5-23 as stated in their plan of correction.
Plan of Correction:	New alarms were ordered, but did not arrive on time to replace by 3/5/23. Alarms will be replaced.
Standard #:	22VAC40-73-750-B
Description:	Based on a tour of the facility the facility failed to ensure that bedrooms contained all required items. Evidence: -Room # 1 which contained two residents only contained one lamp. -Room # 2 which contained two residents only contained one chair, one lamp, and one table.
Plan of Correction:	items missing from rooms will be placed back in rooms.
Standard #:	22VAC40-73-870-A
Description:	Based on observation the facility failed to ensure that the exterior of the building was maintained in good repair. Evidence: The doorbell at the side door entrance that was detached and did not work, as cited during the 3-3-23 inspection, had been removed and had not been replaced by 3-5-23 as stated in the facility?s plan of correction. Photographic evidence was taken.
Plan of Correction:	Doorbell has been replaced.