VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Commonwealth Senior Living at Front Royal
600 Mount View Street
Front royal, VA 22630
(540) 636-2800

Current Inspector: Jeffrey Marnien (540) 571-0189

Inspection Date: June 15, 2023

Complaint Related: No

Areas Reviewed:

22VAC40-73 ADMISSION, RETENTION AND DISCHARGE OF RESIDENTS

Comments:

Type of inspection: Monitoring Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 06/15/2023 from approximately 4:35pm through 6:00pm The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. A self-reported incident was received by VDSS Division of Licensing on 06/08/2023 regarding allegations in the area(s) of: Admission and Retention of Residents . Number of resident records reviewed: 1 Number of staff records reviewed: 1 An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation supported the self-report of non-compliance with standard(s) or law, and violation(s) were issued. Any violation(s) not related to the self-report but identified during the course of the investigation can also be found on the violation notice. 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 Rhonda Whitmer, Licensing Inspector at (540) 292-5932 or by email at rhonda.whitmer@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-310-D
Description:	Based on review of resident?s record, the facility failed to ensure a written letter of assurance, signed by the resident or legal representative was provided to the resident indicating the facility has the appropriate license to meet the care needs at the time of admission. EVIDENCE: The file for resident #1, admitted on 05/22/2023 does not contain a written letter of assurance signed by the resident or their legal representative indicating the facility has the appropriate license to meet the care needs at the time of admission.
Plan of Correction:	Based upon review of the UAI prior to admission of a resident, the assisted living facility administrator shall provide written assurance to the resident that the facility has the appropriate license to meet his care needs at the time of admission. Copies of the written assurance shall be given to the legal representative and case manager, if any, and a copy signed by the resident, or his legal representative shall be kept in the resident's record. All new Residents will have a completed and signed letter of assurance. Ensure all new residents receive a copy of the Letter of assurance and a signed copy is obtained in the business file in the front office. Will conduct an audit of current residents for letter of assurance in business files to be completed by the community by 7/7/2023. Will monitor for continued compliance by weekly monitoring with digital audit tracking log. Title of Responsible person(s) Executive Director or Designee. Business Office Manager or Designee to spot check 4 resident business files a week x3 months.
Standard #:	22VAC40-73-380-A
Description:	Based on review of resident?s record, the facility failed to complete the personal and social information as required prior to or at the time of admission. EVIDENCE: 1. The Resident-Personal/Social Data Sheet in the record for resident #1, admitted 05/22/2023 does not include admission date, last home address; known allergies, interest or hobbies; lifetime vocation, career or primary role; prior service in armed forces; information on advance directives, Do Not Resuscitate (DNR) orders, or organ donation; name, address and phone of legal representative; name, address and phone of personal physician; name, address and phone of personal dentist. 2. The section addressing previous mental health or intellectual disability services history only addresses the name of previous hospital and if resident is applicable for care or services. 3. The section for current behavioral and social functioning is incomplete and does not indicate strengths and problems as required. 4. The section for substance abuse history is not completed to indicate not applicable or if there is a previous history as required.
Plan of Correction:	Prior to or at the time of admission to an assisted living facility, personal and social information on a person shall be obtained with VDSS form 032-05-0006-05-eng (02/18). To include; name, last home address, date of admission, DOB, birthplace, marital status, legal representative information, next of kin information, authorized notification person, name of responsible individual, PCP information, Dentist information, place of worship information, social services information if applicable, services in armed forces, career/vocation, allergies, code status, mental health/intellectual disability information, current social functioning, any hx of substance abuse. The personal and social information required in subsection A of this section shall be placed in the person's record and kept current. All new Residents will have a completed Resident-Personal/Social Data Sheet. Ensure all new residents receive a copy of the VDSS form 032-05-0006-05-eng (02/18) to be completed by resident or designated representative prior to admission. Will conduct an audit of current residents for a completed VDSS form 032-05-0006-05-eng (02/18) for business files and medical charts to be completed by the community by 7/7/2023. Will monitor for continued compliance by weekly monitoring with digital audit tracking log. Title of Responsible person(s) Executive Director or Designee. Resident Care Director or Designee to spot check 4 resident business files and 4 medical charts a week x3 months.