VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Colonial Manor
8679 Pocahontas Trail
Williamsburg, VA 23185
(757) 476-6721

Current Inspector: Willie Barnes (757) 439-6815

Inspection Date: June 30, 2023 , July 18, 2023 and July 24, 2023

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES 22VAC40-73 BUILDINGS AND GROUND

Comments:

Type of inspection: Complaint An on-site complaint inspection conducted on 6-30-23 (AR 09:15/Dep 3:15) The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. A complaint was received by VDSS Division of Licensing on 6-28-23 regarding allegations in the building and grounds area (pest control). Number of residents present at the facility at the beginning of the inspection: 32 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Yes Number of resident records reviewed: Number of staff records reviewed: Number of interviews conducted with residents: Number of interviews conducted with staff: 3 Observations by licensing inspector: Additional Comments/Discussion: collateral contact- consultants interviewed An exit meeting will be conducted to review the inspection findings. Please Note: A copy of the findings of the most recent inspection are required to be posted on the premises of the facility. The evidence gathered during the investigation supported the allegation of non-compliance with standard(s) or law, and violation(s) were issued. Any violation(s) not related to the complaint 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 (Willie Barnes), Licensing Inspector at (757) 439-6815 or by email at willie.barnes@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-70-A
Complaint related:	No
Description:	Based on document reviewed and staff interviewed, the facility failed to report the regional licensing office within 24 hours any major incident that has negatively affected or threatens the life, health, safety or welfare of any resident. Evidence: 1. On 6-30-23, staff #1 acknowledged the facility was being treated for bed bugs. The licensing office did not receive a report of residents being relocated because of the bed bugs in the facility. 2. Staff #1 acknowledged not reporting, the facility having bedbugs.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-870-D
Complaint related:	Yes
Description:	Based on document reviewed and staff interviewed, the facility failed to report the regional licensing office within 24 hours any major incident that has negatively affected or threatens the life, health, safety or welfare of any resident. Evidence: 1. On 6-30-23, staff #1 acknowledged the facility was being treated for bed bugs. The licensing office did not receive a report of residents being relocated because of the bed bugs in the facility. 2. Staff #1 acknowledged not reporting, the facility having bedbugs. Based on documents reviewed and staff interviewed, the facility failed to ensure the building was kept free of infestations of insects and vermin. Evidence: 1. On 6-30-23, during a complaint inspection received on 6-28-23, regarding the facility having bedbugs, the inspector was informed, residents were relocated to another room after a cluster of bedbugs was discovered in the resident #1?s bedroom. Staff #1 and #3 stated residents #1 and #2 were relocated from room #21 to room #31 following discovery of bedbugs in room. 2. Staff #1 stated the residents were moved to another room and the room with the bedbugs was closed/sealed off from anyone entering. 3. On 6-30-23, inspector received copy of an invoice for bed bugs from staff #4 indicating bed bug service on 7-6-23. 4. On 7-18-23, interview with pest control consultant stated conducting treatment for bed bugs at the facility. According to consultant #3, the residents were relocated from room #21 where the bedbugs were located to another room. The room was closed off and the consultant returned to facility to conduct the first treatment on 7-6-23 with a follow-up for 7-11-23. The first treatment was conducted following payment concerns that needed to be addressed with the administrator prior to the beginning of treatment.
Plan of Correction:	Not available online. Contact Inspector for more information.