VIRGINIA DEPARTMENT OF SOCIAL SERVICES

The Haven Assisted Living@Cold Harbor
6367 Cold Harbor Road
Mechanicsville, VA 23111
(804) 779-4847

Current Inspector: Angela Rodgers-Reaves (804) 662-9774

Inspection Date: July 20, 2023 and Sept. 1, 2023

Complaint Related: Yes

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: 07/20/2023-approximate time 9:40a.m-12:40p.m. On 09/01/2023-approximate time 9:05a.m-10: 27a.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 04/10/2023 regarding allegations in the area of Resident Care and Related Services. Number of residents present at the facility at the beginning of the inspection: 6 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 2 Number of staff records reviewed: 1 Number of interviews conducted with residents: 3 Number of interviews conducted with staff: 5 Observations by licensing inspector: Additional Comments/Discussion: An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation did not support the allegations of non-compliance with standard(s) or law. However, violation(s) not related to the complaint but identified during the course of the investigation can 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 Angela Rodgers-Reaves, Licensing Inspector at (804) 840-0253 or by email at Angela.r.reaves@dss.virginia.gov Violation Notice Issued: Yes

Violations:

Standard #:	22VAC40-73-310-B
Complaint related:	No
Description:	Based on the review of facility records and staff and resident interviews the facility failed to ensure that an individual was not admitted before a determination was made that the facility can meet the needs of the individual. The facility shall make the determination based upon the following information at a minimum: 1-Completed UAI (Uniform Assessment Instrument), 2- The physical examination report, 3-Documented interview with the resident. Evidence: Resident #2-Date of admission 07/20/2023 While on site at the facility on 07/20/2023 the inspector observed the resident being brought into the facility by a medical transportation service via a stretcher. Facility staff #1 was the only staff on duty and stated during interview that she did not know the resident?s name, that the resident was a new admission, that the resident is a hospice client and that she did not have any paperwork for the resident. Resident #2 stated during interview stated that she came from a rehabilitation program, could not recall the name but understood that she was a new resident at the facility. Facility staff #2 arrived later to the facility and stated that resident #2 was a referral from hospice and they were waiting on the paperwork. Upon request while onsite at the facility on 07/20/2023 the facility staff #s 1 and 2 did not submit upon request for the inspector?s review documented evidence that a UAI, a complete physical examination report and a documented interview had been conducted as required.
Plan of Correction:	FACILITY'S RESPONSE: "New admission, resident #2 scheduled to arrive at a much later time. Appointment made to meet family and resident at facility once transport arrived to introduce staff. Transport arrived much earlier without notice. Staff had not been introduced to resident at the time of arrival while she was being brought in by transport. Completed file was at the office at the time of inspection having copies made to keep at the facility and office. Discharge paperwork was brought to facility with transport. Hospice nurse notes were being faxed to main office in the meantime to add to the completed file. Plan of correction, administrator will ensure transport is communicated with prior to discharge if discharge times are changed at any point. Resident file placed at the facility on 7/20/2023."
Standard #:	22VAC40-73-310-H
Complaint related:	No
Description:	Based on the review of facility records and staff and resident interviews the facility failed to ensure that in accordance with ? 63.2-1805 D of the Code of Virginia, that the facility did not admit or retain individuals with any of the following conditions or care needs listed in 1-12. Resident #2-Date of admission 07/20/2023 Facility documentation submitted for the inspector?s review from the resident?s previous discharge is not documented to identify diagnosis, results of a risk assessment documenting the absence of tuberculosis in a communicable form or prohibited conditions. While onsite at the facility on 07/20/2023 and upon request facility staff #s 1 and 2 did not submit documented evidence that any of the elements required had been met.
Plan of Correction:	FACILITY'S RESPONSE: "New admission, resident #2 scheduled to arrive at a much later time. Appointment made to meet family and resident at facility once transport arrived to introduce staff. Transport arrived much earlier without notice. Staff had not been introduced to resident at the time of arrival while she was being brought in by transport. Completed file was at the office at the time of inspection having copies made to keep at the facility and office. Discharge paperwork was brought to facility with transport. Hospice nurse notes were being faxed to main office in the meantime to add to the completed file. Plan of correction, administrator will ensure transport is communicated with prior to discharge if discharge times are changed at any point. Resident file placed at the facility on 7/20/2023."
Standard #:	22VAC40-73-325-A
Complaint related:	No
Description:	Based on the review of facility records and staff interviews conducted the facility failed to ensure that a written fall risk rating was completed within 30 days after admission. Evidence: Resident #1-Documented date of admission 01/14/2023. Documented date of discharge 03/31/2023 Upon request during the 07/20/2023 onsite complaint investigation the facility staff #s 1 and 2 did not submit for the inspector?s review documented evidence that a fall risk rating was completed while the resident was in care. The resident was discharged from the facility 03/31/2023.
Plan of Correction:	FACILITY'S RESPONSE: "Fall risk rating completed on 1/14/2023 on date of admission. No corrections to be completed."
Standard #:	22VAC40-73-350-B
Complaint related:	No
Description:	Based on the review of facility records and staff interviews conducted the facility failed to ascertain, prior to admission, whether a potential resident is a registered sex offender if the facility anticipates the potential resident will have a length of stay greater than three days or in fact stays longer than three days and shall document in the resident's record that this was ascertained and the date the information was obtained. Evidence: Resident #2-Date of admission 07/20/2023 Upon request while onsite at the facility on 07/20/2023 facility staff #s 1 and 2 did not submit for the inspector?s review documented evidence that a sex offender search had been conducted for the resident prior to admission.
Plan of Correction:	FACILITY'S RESPONSE: "New admission, resident #2 scheduled to arrive at a much later time. Appointment made to meet family and resident at facility once transport arrived to introduce staff. Transport arrived much earlier without notice. Staff had not been introduced to resident at the time of arrival while she was being brought in by transport. Completed file was at the office at the time of inspection having copies made to keep at the facility and office. Discharge paperwork was brought to facility with transport. Hospice nurse notes were being faxed to main office in the meantime to add to the completed file. Plan of correction, administrator will ensure transport is communicated with prior to discharge if discharge times are changed at any point. Resident file placed at the facility on 7/20/2023."
Standard #:	22VAC40-73-450-C
Complaint related:	No
Description:	Based on the review of facility records and staff interview the facility failed to ensure that a comprehensive individualized service plan (ISP) was completed within 30 days after admission. Evidence: Resident #1-Documented date of admission 01/14/2023. Documented date of discharge 03/31/2023 Upon request during the 07/20/2023 onsite complaint investigation the facility did not submit for the inspector?s review documented evidence that a comprehensive ISP was developed for the resident prior to the residents? 03/31/2023 discharged from the facility. Staff interviews conducted with facility staff #s 1 and 2 and the review of facility records revealed that the resident was admitted to the facility with an indwelling catheter. Upon request to review all ISPs developed for the resident facility staff submitted two different documents; Assisted Living Individualized Service Plan(ISP) and a second document titled Assisted Living Individualized Service Plan Addendum for Enriched Housing Program/Assisted Living Residences; both dated 01/14/2023 but is not documented to identify as the preliminary ISP.
Plan of Correction:	FACILITY'S RESPONSE: "Initial comprehensive ISP completed on date of admission on date of 1/14/2023. Per state regulation 22VAC40-73-450. (A), if the comprehensive ISP is completed, the preliminary ISP is no longer required. Document discussed had at the bottom right corner pages 1-6. Document page number 5 stating amended of enriched housing program/assisted living residences, states if applicable and because it applies to assisted living, it is all part of the same 6 page ISP. It is all one document completed comprehensive ISP. No corrections to be completed.: