VIRGINIA DEPARTMENT OF SOCIAL SERVICES

The Harmony Collection @ Hanover Assisted Living and Memory Care
8227 Meadowbridge Road
Mechanicsville, VA 23116
(804) 212-2110

Current Inspector: Tamara Watkins (804) 662-7422

Inspection Date: Feb. 8, 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 22VAC40-80 COMPLAINT INVESTIGATION 22VAC40-80 SANCTIONS

Comments:

Type of inspection: Monitoring Date(s) of inspection and time the licensing inspector was on-site at the facility 2/8/2023 2:10p ? 5:45p. 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: 89 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 10 Number of staff records reviewed: 5 Number of interviews conducted with residents: 2 Number of interviews conducted with staff: 3 Observations by licensing inspector: Staff resident interaction, activities, medication administration, postings Additional Comments/Discussion: 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 Tamara Watkins, Licensing Inspector at (804) 662-7422 or by email at tamara.g.watkins@dss.virginia.gov Violation Notice Issued: Yes

Violations:

Standard #:	22VAC40-73-1100-A
Description:	Based on a review of resident records the facility failed to obtain written approval prior to placement of residents in a secure environment. Evidence: There were no written placement approvals retained in the residents file available for review for resident #3, date of admission 9/30/22; and resident #6, date of admission 9/2022. The facility admitted they were unable to locate the approvals.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-250-C
Description:	Based on a review of staff files the facility failed to obtain a criminal history record report on or prior to the date of employment. Evidence: There were no staff criminal history record reports for staff #1,4,&5; dates of employment 9/12/22; date unknown for staff #4 and 6/20/19 respectively.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-250-D
Description:	Based on a review of staff files the facility failed to document that staff completed an annual tuberculosis screening. Evidence: There were no current screening forms documenting the absence of tuberculosis for staff # 1-5.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-325-C
Description:	Based on a review of resident records the facility failed to show documentation of an analysis of the circumstances of a fall and interventions initiated to prevent or reduce subsequent falls. Evidence: There is no information on a fall that resident #2 experienced that required stitches or a hospital discharge statement.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-430-H-1
Description:	Based on a review of resident records the facility failed to provide and retain a dated statement at the time of discharge. Evidence: There was no discharge statement retained in the file for resident #7 indicating the reason or date of discharge.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-440-A
Description:	Based on a review of resident records the facility failed to complete an annual review of the Uniform Assessment Instrument. Evidence: Resident #1 was admitted to the facility on 1-26-2019. The last UAI completed and in the resident file was for resident #2 was on 2/14/2019. There were no UAI?s in the resident files for resident #3 date of admission 9/30/22; & resident #6 date of admission 9/2022.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-450-C
Description:	Based on a review of resident records the facility failed to complete a comprehensive service plan within 30 days after admission. Evidence: Resident #8 was admitted to the facility on 1-3-23 and an initial service plan was completed on 12/30/22. There was an updated service plan due on 1/30/23 but one was not completed.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-450-F
Description:	Based on a review of resident records the facility failed to review and update individualized service plans once every (12) twelve months. Evidence: The last ISP in the file for resident #2 was 9-23-21.
Plan of Correction:	Not available online. Contact Inspector for more information.