VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Essex House
17976 Tidewater Trail
Tappahannock, VA 22560
(804) 443-5921

Current Inspector: Yvonne Randolph (804) 662-7454

Inspection Date: Aug. 28, 2023

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 RESIDENT CARE AND RELATED SERVICES

Comments:

Type of inspection: Complaint Date of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 8/28/23, 12:30 pm The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. A complaint was received by VDSS Division of Licensing on 8/1/23 followed by a self-report on 8/2/23 regarding an allegation in the areas: Resident Care and Related Services Number of staff records reviewed: 0 Number of interviews conducted with residents: 1 Number of interviews conducted with staff: 1 An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation supported the allegations 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 Yvonne Randolph, Licensing Inspector at (804)662-7454 or by email at yvonne.randolph@dss.virginia.gov an

Violations:

Standard #:	22VAC40-73-460-A
Complaint related:	Yes
Description:	Based on a complaint investigation, it was determined that the facility failed to assume general responsibility for the health, safety and well-being of a resident in care. Evidence: Resident # 1 suffered injuries that required emergency care during staff attempts to restrict her movement at the facility. (Photo of injury reviewed)
Plan of Correction:	All staff will be trained upon hire and ongoing during their employment per our policy: Restraint use & behavior, mandated reporting, aggressive behavior, procedures for handling resident emergencies, job description for person-in-charge organizational chart, code of conduct. All in-service will be documented for review.
Standard #:	22VAC40-73-710-B
Complaint related:	No
Description:	Based on a complaint investigation, it was determined that physical restraints were imposed on a resident for purposes of staff convenience and without a written physician order. Evidence: 1. Resident # 1 reported during an interview that staff would place a gate and chairs at the entrance of the door to her room. 2. Staff # 1 admitted to placing a gate/chairs at the door to the room of resident # 1 so that resident # 1 ?could not get out of her room when it is time to get the other residents up in the morning?. 3. There was no written physician order.
Plan of Correction:	Staff # 1 was immediately placed on suspension(8/1/23) pending investigation. This incident was self-reported to DSS. Upon completion of internal investigation staff # 1 was terminated on 8/9/23. Resident # 1 was admitted to VCU hospital seeking medical treatment for an infection.