VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Covenant Columns
510 Park Avenue
Richmond, VA 23223
(804) 222-5133

Current Inspector: Shelby Haskins (804) 305-4876

Inspection Date: May 18, 2023

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 ADMISSION, RETENTION AND DISCHARGE OF RESIDENTS 22VAC40-73 RESIDENT CARE AND RELATED SERVICES

Comments:

Type of inspection: Complaint Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 5-18-2023 8:57 ? 10:00 a.m. 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 3/24/2023 regarding allegations in the areas of Resident Care and Related Services. Number of residents present at the facility at the beginning of the inspection: 9 An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation supported some, but not all of the allegations; area(s) of non-compliance with standard(s) or law were: Admission, Retention, and Discharge of Residents; and Resident Care and Related Services A violation notice was 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 Alex Poulter, Licensing Inspector at (804)662-9771 or by email at alex.poulter@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-320-A
Complaint related:	No
Description:	Based on record review and interview with staff, the facility failed to ensure within the 30 days preceding admission, a person shall have a physical examination by an independent physician. Evidence: Resident #4 admitted 2-06-2023. Resident #4 did not have a physical examination on file. Staff #1 stated, ?it was an emergency placement? as to the reason why a physical examination was not on file for Resident #4.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-450-C
Complaint related:	No
Description:	Based on record review and interview with staff, the facility failed to ensure the comprehensive individualized service plan (ISP) included a description of identified needs based upon the UAI. Evidence: Resident #1 admitted 2-06-2023. Resident #1?s current ISP did not identify money management as a service need; however, the current UAI documented ?Yes? to money management as a service need.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-450-E
Complaint related:	No
Description:	Based on record review and interview with staff, the facility failed to ensure the individualized service plan (ISP) was signed and dated by the resident or his legal representative. These requirements shall also apply to reviews and updates of the plan. Evidence: 1. Resident #1 through Resident #4?s ISPs were not signed and dated by the resident or his legal representative. 2.Staff #1 confirmed during onsite interview with the licensing inspector that the four ISPs were not signed and dated by the residents? or residents? responsible parties as required.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-450-F
Complaint related:	No
Description:	Based on record review, the faciltiy failed to ensure individualized service plans ISPs)were reviewed and updated as needed for a significant change of a resident?s condition. Resident #2 admitted 2-06-2023. Resident #2?s current ISP did not identify toileting assistance; however, the current UAI documented human help, supervision for toileting. Resident #3 admitted 2-06-2023. Resident #3?s current ISP identified physical assistance for bathing and did not identify toileting as a service need; however, the current UAI identified mechanical and human assistance, supervision for bathing and toileting.
Plan of Correction:	Not available online. Contact Inspector for more information.