VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Guardian Assisted Living
99 Culbertson Lane
Castlewood, VA 24224
(276) 794-9569

Current Inspector: Crystal Mullins (276) 608-1067

Inspection Date: Sept. 27, 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

Comments:

Type of inspection: Monitoring Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 09/27/2023 Begin: 9:30am End: 2:00pm 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: 23 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 6 Number of staff records reviewed: 3 Number of interviews conducted with residents: 2 Number of interviews conducted with staff: 2 Observations by licensing inspector: Additional Comments/Discussion: An exit meeting will be conducted to review the inspection findings he 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 Crystal B. Henson Licensing Inspector at 276-608-1067 or by email at crystal.b.mullins@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-750-E
Description:	Based on the tour of the facility, the facility failed to have sufficient bed linens in good repair so that residents always have clean sheets. EVIDENCE: 1. In house #1, resident room #3 was found to have sheets on the middle bed that had brownish colored stains (stained from coffee perhaps) and specks of some substance-either dirt or leftover food crumbles.
Plan of Correction:	Facility does have sufficient bed linens to change soiled linen as needed. Staff have been instructed to check and change beds more frequently for residents who choose to eat and drink and lay in the bed during the day. All resident bed are checked every morning and changed as needed. [sic]
Standard #:	22VAC40-73-860-G
Description:	Based on the tour of the facility, the facility failed to maintain all hot water taps available to residents with the range of 105 degrees Fahrenheit and 120 degrees Fahrenheit. EVIDENCE: 1. In house #2, the common bathroom across from resident room #3, the hot water reached a maximum temperature of 100.5 degrees Fahrenheit. 2. In house #2, the common bathroom across from resident room #1 was found to have a hot water temperature in the left sink at 132.1 degrees Fahrenheit, and the right sink measured at 131.5 degrees Fahrenheit.
Plan of Correction:	Maintenance will maintain all hot water temps available to residents at a range of 105 degree Fahrenheit to 120 degree Fahrenheit. Water temperature checked weekly by administrator. [sic]
Standard #:	22VAC40-73-870-B
Description:	Based on the tour of the facility, the facility failed to keep all buildings well-ventilated and free from foul, stale, and musty odors. EVIDENCE: 1. In house #1, the downstairs common bathroom with #9 on the door was observed to have a foul odor of what was thought to be urine.
Plan of Correction:	Staff have been instructed to clean and disinfect bathrooms frequently to eliminate foul odors. [sic]
Standard #:	22VAC40-73-870-E
Description:	Based on the tour of the facility, the facility failed to keep all furnishings, fixtures, and equipment including furniture, window coverings, sinks, toilets, bathtubs, and showers clean and in good repair and condition. EVIDENCE: 1. In house #2 the hallway straight across from resident room #5 the overhead light was not operable. 2. In house #1 the common bathroom across from the medication room was observed to have a broken lid on the tank of the toilet. 3. In house #1, the common bathroom with #9 on the door was found to have a brown substance in the corner of the shower under the water faucet. This area appeared to be stained with dirt or perhaps rust. This same common bathroom had a liquid substance in the floor at the base of the toilet, the odor indicated this was possibly urine.
Plan of Correction:	Hallway light being replaced by maintenance. Toilet tank lid being replaced by maintenance. Staff have been instructed to clean and disinfect bathrooms frequently to eliminate foul odors and cut down on water stains around faucets. [sic]