VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Cambridge Crossing Assisted Living
251 Patriot Lane
Williamsburg, VA 23185
(757) 220-4014

Current Inspector: Willie Barnes (757) 439-6815

Inspection Date: Sept. 8, 2023 and Sept. 14, 2023

Complaint Related: Yes

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 22VAC40-80 COMPLAINT INVESTIGATION

Comments:

Type of inspection: Complaint An on-site complaint investigation was conducted on 9-8-23 (AR 09:03 a.m./Dep 1:25 p.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 9-5-23 regarding allegations in the staffing and supervision, resident care and related services, food, building and grounds and management. Number of residents present at the facility at the beginning of the inspection: 14 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: 1 Number of staff records reviewed: NA Number of interviews conducted with residents: Number of interviews conducted with staff: 4 Observations by licensing inspector: tour of building Additional Comments/Discussion: current license and new licensee?s records- what are the dates of hire for staff, date of admissions for residents, new licensee?s procedures for current license and staff/ residents and outside dining contract. 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 valid. 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 (Willie Barnes), Licensing Inspector at (757) 439-6185 or by email at willie.barnes@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-50-A
Complaint related:	No
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure the facility prepared and provided a statement to the prospective resident and legal representative, if any, that discloses information about the facility. This statement shall be on a form developed by the department and shall include all required information. Written acknowledgement of the receipt of the disclosure shall be retained in the resident?s record. Evidence: 1. On 9-8-23 during a complaint investigation, resident #1?s record did not have documentation of a signed and dated disclosure for the current licensee. 2. Staff #1 acknowledged the resident?s record did not have documentation of the disclosure for the current licensee.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-390-A
Complaint related:	No
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure at or prior to the time of admission, there was a written agreement/acknowledgement of notification dated and signed by the resident or applicant for admission or the appropriate legal representative, and by the licensee or administrator. The document shall include all required information. Evidence: 1. On 9-8-23 during a complaint investigation, resident #1?s record did not have documentation of a signed and dated written agreement/acknowledgement of notification for services signed and dated by the licensee or administrator. 2. Staff #1 acknowledged the resident?s record did not include a signed and dated written agreement/acknowledgment of notification for services.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-440-A
Complaint related:	No
Description:	Based on record reviewed, the facility failed to ensure a resident of and applicant to the assisted living facility was assessed face to face using the uniform assessment instrument (UAI) in accordance with Assessment in Assisted Living Facilities. The UAI shall be completed prior to admission, at least annually, and whenever there is a significant change in the resident?s condition. Evidence: 1. On 9-8-23 during a complaint investigation, resident #1?s record did not include a completed UAI for admission to the current licensed facility. 2. Staff #1 acknowledged the resident?s record did not have an UAI for the current licensee.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-450-A
Complaint related:	No
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure on or within seven days prior to the day of admission, a preliminary plan of care was developed to address the basic needs of the resident that adequately protects the resident?s health, safety, and welfare. Evidence: 1. On 6-8-23 during a complaint investigation, resident #1?s record did not include documentation of a preliminary plan of care for the current licensed facility. 2. Staff #1 acknowledged the resident?s record did not have a preliminary plan of care.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-610-B
Complaint related:	No
Description:	Based on observation and staff interviewed, the facility failed to ensure the snacks menu for the current week was dated and posted in an area conspicuous to residents. Evidence: 1. On 9-8-23, during a complaint investigation, a tour of the dining area was conducted with staff #1 and #2. The current week snack menu was not observed being posted. 2. Staff #1 acknowledged the current week snack menu was not posted.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-870-G
Complaint related:	No
Description:	Based on observation and staff interviewed, the facility failed to ensure the grounds was properly maintained. Evidence: 1. On 9-8-23 during a complaint investigation, the grounds to the courtyard located on the side of the dining room, was observed to have some tall grass. This grass and flowering were located behind the seating chairs in the courtyard. 2. This is a repeat violation from the 7-25-23 initial inspection. 3. Staff #1 and #4 acknowledged the tall grass and flowering remained as it was when first observed on 7-25-23.
Plan of Correction:	Not available online. Contact Inspector for more information.