VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Runk & Pratt of Forest
208 Gristmill Drive
Forest, VA 24551
(434) 385-0297

Current Inspector: Jennifer Stokes (540) 589-5216

Inspection Date: Aug. 29, 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: Renewal Date of inspection and time the licensing inspectors were on-site at the facility for each day of the inspection: 08/29/2023 9:00AM until 1:00PM 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: 61 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 8 Number of staff records reviewed: 4 Number of interviews conducted with staff: 4 Observations by licensing inspector: audit of medication carts, observation of noon-time medication pass, observation of noon-time meal An exit meeting will be conducted to review the inspection findings. 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 Jennifer Stokes, Licensing Inspector at 540-589-5216 or by email at Jennifer.Stokes@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-860-G
Description:	Based on observation during a tour of the facility physical plant, the facility failed to ensure that hot water at taps available to residents is maintained within a range of 105 degrees Fahrenheit to 120 degrees Fahrenheit. EVIDENCE: During on-site inspection from approximately 9:12AM until 9:20AM the following water temperatures at residents? bathroom sinks were documented by the licensing inspectors: 101.8 degrees Fahrenheit in room B7, 99.7 degrees Fahrenheit in room C4, 102 degrees Fahrenheit in room E3 and 102.3 degrees Fahrenheit in room E5.
Plan of Correction:	Maintenance contacted, water temperatures corrected. Maintenance will perform random checks and plan to check quarterly to address water temperatures.
Standard #:	22VAC40-73-930-D
Description:	Based on resident record review, the facility failed to ensure that documentation of daily rounds was completed for residents with an inability to use a signaling device. EVIDENCE: 1. The individualized service plan (ISP) for resident 9, dated 02/20/2023, indicates an identified need that the resident is to receive safety checks every two hours due to the resident?s inability to use the call bell. The August 2023 every two hour check off sheet for resident 9 provided on the day of the inspection does not have documentation of staff initials for two-hour checks being completed for multiple dates and times during the month. 2. The ISP for resident 10, dated 02/25/2023, indicates an identified need that the resident is to receive safety checks every two hours due to the resident?s inability to use the call bell. The August 2023 every two hour check off sheet for resident 10 provided on the day of inspection does not have documentation of staff initials for two-hour checks being completed from 3:00PM until 9:00PM on 08/25/2023. 3. The ISP for resident 11, dated 07/10/2023, indicates an identified need that the resident is to receive safety checks every two hours due to the resident?s inability to use the call bell. The August 2023 every two hour check off sheet for resident 11 provided on the day of inspection does not have documentation of staff initials for two-hour checks being completed from 11:00PM until 5:00AM on 08/27/2023.
Plan of Correction:	On August 31st a direct care inservice was held educating staff on proper documentation of two-hour safety checks.
Standard #:	22VAC40-73-980-A
Description:	Based on an observation of the facility?s first aid kit, the facility failed to ensure that items in the first aid kit with expiration dates did not have dates that have already passed. EVIDENCE: A tube of Bacitracin Zinc ointment was noted within the facility?s first aid kit to have an expiration date of March 2019.
Plan of Correction:	The tube of Bacitracin Zinc ointment was removed the day of inspection. Bacitracin Zinc ointment presently in first aid kit dated til January 2024.