VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Commonwealth Senior Living At Charlottesville
1550 Pantops Mountain Place
Charlottesville, VA 22911
(434) 977-4094

Current Inspector: Coy Stevenson (804) 972-4700

Inspection Date: March 7, 2023

Complaint Related: No

Areas Reviewed:

22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-90 BACKGROUND CHECKS FOR ASSISTED LIVING FACILITIES

Technical Assistance:

PRN oxygen therapy on care plan Dates outcome achieved on care plan TB Screening forms

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: 3-07-2023, 8:59 ? 11:45 a.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: 61 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 8 Number of staff records reviewed: 3 An exit meeting will be 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 Alexandra Poulter, Licensing Inspector at (804)662-9771 or by email at alex.poulter@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-700-1
Description:	Based on record review and interview with staff, the facility failed to ensure there was a valid physician?s order that included the oxygen source and delivery device deemed therapeutic for the resident. Evidence: 1. Resident #1 admitted 3-10-2021. Resident #1?s record contained a physician?s order dated 12-13-2022 that documented, ?PRN OXYGEN: 1-2 LITERS AS NEEDED FOR SHORTNESS OF BREATH?; however, the order did not specify the oxygen source (such as compressed gas or concentrators) or the delivery device (such as nasal cannula, reservoir nasal cannulas, or masks). 2. Staff #1 acknowledged during interview regarding Resident #1?s physician?s order.
Plan of Correction:	Resident Care Director has received the corrected order addressing the oxygen source. The Executive Director, Resident Care Director or designee will audit files of current residents that utilize oxygen and review orders for new residents to ensure orders are properly documented addressing appropriate items per regulatory compliance.
Standard #:	22VAC40-90-40-C
Description:	Based on record review and interview with staff, the facility failed to ensure they did not continue to employee who has a conviction of any of the barrier crimes. Evidence: 1. Upon review of staff records and confirmation with Staff #2 on 4-10-2023, the facility had hired Staff #6 who had a conviction of a barrier crime on record check dated 12-12-2022. 2. Staff #2 confirmed that Staff #6 had the conviction in 2009 and was still employed as of 4-10-2023.
Plan of Correction:	Executive Director, Business Office Manager, and designee will ensure current employee files are audited for employees, sworn disclosure statement and their criminal background check to ensure we are following the appropriate regulatory standards and new hire employees will not be allowed to start until background check has been received and reviewed for barrier crimes that would disqualify employment.