VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Hairston Home for Adults
601 Armstead Ave
Martinsville, VA 24112
(276) 638-5121

Current Inspector: Angela Marie Swink (276) 623-6575

Inspection Date: Jan. 10, 2024

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-73 BUILDINGS AND GROUND 22VAC40-80 COMPLAINT INVESTIGATION

Comments:

Type of inspection: Complaint 58678 Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 01/10/2024 from 08:30 AM until 12:00 PM 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 12/14/2023 regarding allegations in the area(s) of: Building and Grounds and Resident Care and Related Services. Number of residents present at the facility at the beginning of the inspection: 30 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 3 Number of staff records reviewed: N/A Number of interviews conducted with residents: N/A Number of interviews conducted with staff: 3 Observations by licensing inspector: N/A Additional Comments/Discussion: N/A An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation did not support the allegation(s) of non-compliance with standard(s) or law. However, violation(s) not related to the complaint(s) 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 Holly Copeland, Licensing Inspector, at 540-309-5982 or by email at holly.copeland@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-440-A
Complaint related:	No
Description:	Based on resident record review and staff interview, all residents of assisted living facilities shall be assessed face to face using the uniform assessment instrument in accordance with Assessment in Assisted Living Facilities (22VAC30-110-30-B.2) which includes the identification of functional status of public pay individuals. EVIDENCE: 1. During an on-site inspection on 1/10/2024, the Individual Service Plan (ISP) in the record for resident 3, dated 1/17/2023, does not identify bladder incontinence as a need; however, the UAI in the record for resident 3, dated 11/4/2022, indicates that the resident?s bladder incontinence is managed through an External Device/Indwelling/Ostomy self-care. 2. During an interview with two Licensing Inspectors (LIs) and staff person 1, staff person 1 revealed that the ISP is accurate as resident 3 is independent with bladder continence. 3. During an on-site inspection on 1/10/2024, the ISP in the record for resident 2, dated 8/30/2023, indicates the resident is independent in transferring and mobility; however, the UAI in the record for resident 2, dated 9/14/2023, indicates supervision is needed for transferring and mobility. 4. During an interview with two LIs and staff person 1, staff person 1 revealed the ISP is accurate as resident 2 is independent with transferring and mobility. 5. During an on-site inspection on 1/10/2024, the ISP in the record for resident 1, dated 7/31/2022, indicates the resident needs human help and physical assistance for bathing; however, the UAI in the record for resident 1, dated 9/14/2023, indicates that only mechanical help is needed for bathing. 6. During an interview with two LIs and staff person 1, staff person 1 revealed the ISP is accurate as resident 1 needs human help and physical assistance for bathing.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-450-C
Complaint related:	No
Description:	Based on resident record review and staff interview, the facility failed to ensure the comprehensive Individualized Service Plan (ISP) shall include a description of identified needs and date identified based upon the Uniform Assessment Instrument (UAI). EVIDENCE: 1. During an on-site inspection on 1/10/2024, the UAI in the record for resident 3, dated 11/4/2022, indicates that the resident needs mechanical help only for bathing and walking and stairclimbing is not performed; however, the ISP in the record for resident 3, dated 1/17/2023, does not identify the needs of bathing, walking, and stairclimbing. 2. During an interview with two licensing inspectors (LIs) and staff person 1, staff person 1 revealed that the UAI accurately reflects the needs of resident 3.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-450-F
Complaint related:	No
Description:	Based on resident record review and staff interview, 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. During an on-site inspection on 1/10/2024, the UAI in the record for resident 2, dated 9/14/2023, indicates that the resident is incontinent weekly of bladder; however, the ISP in the record for resident 2, dated 7/31/2022, does not identify the need for help for bladder incontinence. 2. During an interview with two licensing inspectors (LIs) and staff person 1, staff person 1 revealed that the UAI for the resident is accurate as resident 2 is incontinent weekly of bladder.
Plan of Correction:	Not available online. Contact Inspector for more information.