VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Covenant Columns
510 Park Avenue
Richmond, VA 23223
(804) 222-5133

Current Inspector: Shelby Haskins (804) 305-4876

Inspection Date: Aug. 28, 2023

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES

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: 8-28-2023, 1:30 ? 2 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 8-28-2023 regarding allegations in the area of: Resident Care and Related Services. Number of residents present at the facility at the beginning of the inspection: 10 The licensing inspector completed the inspection with local Adult Protective Services worker on the date above. Number of resident records reviewed: 1 Number of staff records reviewed: 0 Number of interviews conducted with residents: 1 Number of interviews conducted with staff: 2 An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation did not support the allegation 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 Alex Poulter, Licensing Inspector at (804)662-9771 or by email at alex.poulter@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-70-A
Complaint related:	No
Description:	Based on record review, observation and interview, the facility failed to 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. According to an internal facility incident report, the following occurred on 8-20-2023 at approximately 8:00 a.m.: A.Resident #1 was observed by Staff #2 to have a rash on her chest. B.Staff #2 contacted Staff #1 who contacted Resident #1?s son. Resident #1?s son took the resident to an urgent care center, where it was confirmed the resident had a burn on her chest (likely from hot food or beverage). 2. Staff #1 confirmed during interview that the incident that occurred involving Resident #1 on 8-20-2023 was not reported to the regional licensing office within 24 hours. 3. Licensing Staff and APS Worker observed the injury on Resident #1 on 8-28-2023 during inspection, that appeared to be in the healing stages.
Plan of Correction:	Not available online. Contact Inspector for more information.