VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Brookdale Roanoke
1127 Persinger Road, S.W.
Roanoke, VA 24015
(540) 343-4900

Current Inspector: Holly Copeland (540) 309-5982

Inspection Date: April 11, 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 22VAC40-90 THE SWORN STATEMENT OR AFFIRMATION 22VAC40-90 THE CRIMINAL HISTORY RECORD REPORT

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: 04/11/2023 from 08:55 AM until 03:00 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 #:	22VAC40-73-250-D
Description:	Based on staff record review and staff interview, the facility failed to ensure each staff person on or within seven days prior to the first day of work at the facility submitted the results of a risk assessment, documenting the absence of tuberculosis (TB) in a communicable form as evidenced by the completion of the current screening form published by the Virginia Department of Health (VDH) or a form consistent with it. EVIDENCE: 1. The record for staff 2, date of hire 08/30/2022, contained a VDH TB risk assessment form for staff 2; however, the document did not contain a date of when the risk assessment was completed. 2. Interview with staff 6 confirmed this was accurate and there was no other TB risk assessment document for staff 2 to indicate this was done on or within seven days prior to staff 2?s first day of work.
Plan of Correction:	? A new TB risk assessment form will be completed for Staff 2. ? BOM/ED or designee will complete an audit of all staff charts to verify that all TB risk assessments are complete.
Standard #:	22VAC40-73-860-I
Description:	Based on observation during a tour of the building, the facility failed to ensure that cleaning supplies and other hazardous materials were stored in a locked area. EVIDENCE: At approximately 9:21AM during on-site inspection, collateral 1 (LI) noted a container of Super Sani-cloth germicidal disposable wipes and a spray bottle of 14 Antibacterial All-Purpose Cleaner located in the unlocked cabinet above the small sink in the Cottage kitchen. Both items contained a warning to keep out of reach of children.
Plan of Correction:	? The items noted have been removed from the unlocked cabinet in the Cottage kitchen. ? Executive Director (ED)/Health and Wellness Coordinator (HWC)/Resident Care Coordinator (RCC)/Maintenance Manager (MM)/Sales Manager (SM) or designee will complete an audit of all 4 neighborhoods and all 56 resident rooms to verify that cleaning supplies and other hazardous materials are stored in a locked area. The ED will be responsible for directing additional corrective action based on audit findings. ? HWC/RCC/ED or designee will provide re-training to staff on appropriate storage of cleaning supplies and hazardous materials.
Standard #:	22VAC40-73-870-A
Description:	Based on observation during a tour of the building, the facility failed to ensure that the interior of the building was maintained in good repair, kept clean and free of rubbish. EVIDENCE: 1. The flooring in front of the dresser in room 35 contained a large area of a dark staining. Also, collateral 1 (LI) noted a quarter sized hole in the flooring beside the end of bed in room 35. 2. It was noted by collateral 1 that the carpet in the back corner beside the window in the Cottage living room contained a large area of staining. The carpet in the Cottage living room contained small pieces of debris along the baseboards, mainly behind the furniture. The baseboards in the Cottage dining room contained areas of peeling and chipping white paint. Also, in the Cottage dining room, the wall by a table that is pushed up against the wall appeared that something had been spilled down the wall. 3. The baseboards in the Country dining room contained areas of peeling and chipping white paint
Plan of Correction:	? The flooring in room 35 will be replaced by the Maintenance Manager or designee. ? The carpet in the Cottage living room will be vacuumed and cleaned by the Maintenance Manager or designee. ? The baseboards in the Cottage dining room will be painted and the walls in the Cottage dining room will be cleaned by the Maintenance Manager or designee. ? The baseboards in the Country dining room will be painted by the Maintenance Manager or designee.