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. 17, 2023 and Nov. 3, 2023

Complaint Related: Yes

Areas Reviewed:

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 22VAC40-80 COMPLAINT INVESTIGATION

Comments:

Comments/Discussion: Type of inspection: Complaint An on-site complaint inspection was conducted on 9-27-23 (Ar 09:27/Dep 14:15). 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 9-25-23 regarding allegations in the resident care and related services: medication- care and staffing. Number of residents present at the facility at the beginning of the inspection: 13 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: 3 Number of staff records reviewed: 0 Number of interviews conducted with residents: 1 Number of interviews conducted with staff: 4 Observations by licensing inspector: Additional Comments/Discussion: 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 was 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 757-439-6815 or by email at willie.barnes@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-70-A
Complaint related:	Yes
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure it report to the regional licensing office within 24 hours any major incident that has negatively affected or that threatens the life, health, safety, or welfare of any resident. Evidence: 1. On 9-13-23, resident #2?s record included documentation of resident?s stay in the hospital from 9-8-23 to 9-18-23.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-310-H
Complaint related:	No
Description:	Based on records reviewed and staff interviewed, the facility failed to ensure it did not admit retain individuals with a prohibitive conditions or care needs. 1. On 9-27-23, resident #2?s record included a prescription dated 9-19-23 for Lorazepam. The record did not include a treatment plan for this psychotropic medication.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-450-C
Complaint related:	No
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure that the individualized service plan (ISP) included all assessed needs. Evidence: 1. On 9-27-23, resident #1?s uniform assessment instrument (UAI) dated 2-28-23, reassessed 3-16-23 noted toileting need assessed as mechanical help/human help/physical assistance. The ISP dated 3-22-23 noted staff to provide supervision/ cueing. Bladder assessed as less than weekly; the ISP noted bladder incontinence need weekly or more. The resident?s signed physician?s order dated 8-2-23 noted resident allergic to Celexa, Verapamil, Ace Inhibitors, Sulfa and Egg. The ISP noted allergy to Sulfa and Verapamil. Home health service document dated 6-15-23 noted resident discharged from physical therapy services; occupational therapy (OT) service note dated 6-13-23 discharge at next visit, resident no longer participating in services. These changes were not noted on the resident?s ISP- outcome achieved.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-450-D
Complaint related:	No
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure when hospice care is provided to a resident, the services provided by each shall be included on the individualized service plan (ISP). Evidence: 1. On 9-27-23, resident #2?s record included documentation of hospice services being provided, start of care 9-19-23. The ISP dated 9-15-22 was not updated to include this service.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-450-E
Complaint related:	No
Description:	Based on record reviewed and staff interviewed the facility failed to ensure the individualized service plan (ISP) was signed and dated by the licensee, administrator, or designee and the resident or resident?s legal representative. Evidence: 1.On 9-27-23, resident #3?s ISP dated 9-19-23 was not signed by the resident and/or resident?s legal representative.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-450-F
Complaint related:	No
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure the individualized service plan (ISP) shall be reviewed and updated at least once every 12 months and as needed for a significant change of a resident?s condition. Evidence: 1. On 9-27-23, resident #2?s record included speech therapy (ST) services dated 6-29-23 and 7-6-23. The ISP dated 9-15-22 did not include this service. 2. On 9-27-23, resident #3?s uniform assessment instrument (UAI) dated 9-19-23 noted dressing need assessed as human help/supervision. The ISP dated 9-19-23 noted staff to assist resident with taking off and putting on clothing.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-680-I
Complaint related:	No
Description:	Based on record review and staff interviewed, the facility failed to ensure medication administration record (MAR) did not include all required information. Evidence: 1. On 9-27-23, resident #2?s September 2023 medication administration record (MAR) did not include the initials of direct care staff administering Melatonin medication on 9-2-23 and 9-3-23, 9 p.m. scheduled time. The MAR also did not include the initials of direct care staff administering Zyprexa on 9-2-23 and 9-3-23, 8 p.m. scheduled time.
Plan of Correction:	Not available online. Contact Inspector for more information.