VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Commonwealth Senior Living at Cedar Manor
1324 Cedar Road
Chesapeake, VA 23222
(757) 548-4192

Current Inspector: Donesia Peoples (757) 353-0430

Inspection Date: June 13, 2023

Complaint Related: No

Areas Reviewed:

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 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS

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: An unannounced monitoring inspection took place on 06/13/2023 at 11:35 am to 2:30 pm. 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 05/03/2023 and 05/05/2023 regarding allegations in the area(s) of: Resident Care and Related Services Number of residents present at the facility at the beginning of the inspection: 79 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 3 Number of staff records reviewed: 2 Number of interviews conducted with residents: 1 Number of interviews conducted with staff: 1 Observations by licensing inspector: An observation of the safe, secure unit was completed. Additional Comments/Discussion: None 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 (Donesia Peoples), Licensing Inspector at (757) 353-0430 or by email at donesia.peoples@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-460-A
Description:	Based on an interview and record review the facility failed to assume general responsibility for the health, safety, and well-being of the residents. Evidence: 1. The record for resident #1 contains the following documentation: a progress noted dated 05/03/23 documents ?resident #1 pushed other resident and other resident fell onto the floor;? an incident report dated 05/12/2023 documents ?staff observed resident #1 pushing resident #3 against the glass window with resident #1 hands at resident?s #2 clavicle;? a progress note dated 05/18/23 documents ?staff witnessed resident #1 attempting to pull another resident? out of the other resident?s bed, ?resident #1 then proceeded to go into other residents? room;? an incident report dated 06/01/23 documents ?resident #1 was exiting resident?s #2 room. Resident #2 reported resident #1 beat her up and choked her. RMA noted bleeding from resident?s #2 left hand as well as swelling to resident?s face near eye. EMS arrived and transported resident #2 to the hospital. 2. The record for resident #3 contains a progress noted dated 05/05/23 that documents ?resident #1 became aggressive placing hand on resident?s #3 throat and pushing resident # 3 towards wall.? 3. During an interview with resident # 2 on 06/13/23, resident #2 confirmed being hit in the eye and face by resident #1.
Plan of Correction:	Resident Care Director/ Assistant Resident Care Director/ or designee will review EHR notes weekly for any updates or changes not communicated in the 24-hour nursing book. RCD or designee will communicate changes in behaviors to Executive Director in a timely manner. RMAs and RCAs will be in serviced on documentation in EHR as well as aggressive behavior form. RMAs and RCAs will be in serviced on Aggressive behaviors and situation awareness.