VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Brookdale Chambrel Williamsburg
3800 TREYBURN DRIVE
Williamsburg, VA 23185
(757) 220-1839

Current Inspector: Margaret T Pittman (757) 641-0984

Inspection Date: Oct. 30, 2023 , Jan. 30, 2024 , Jan. 31, 2024 and Feb. 8, 2024

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES 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:

Type of inspection: Complaint An on-site complaint inspection was conducted by two inspectors from the Peninsula Licensing Office on 10-30-23. Ar. 09:28 a.m./dep 17:00 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 9-26-23 regarding allegations in the of resident care and related services. Number of residents present at the facility at the beginning of the inspection: C- main building 52 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: 0 Number of interviews conducted with residents: 3 Number of interviews conducted with staff: 11 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 (Willie Barnes), Licensing Inspector at (757) 439-6815 or by email at willie.barnes@dss.virginia.gov

Violations:

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 for one of three records reviewed. Evidence: 1. On 10-30-23, resident #1?s September and October 2023 medication administration records (MAR)s documented resident administered Mirtazapine and Wellbutrin. The record did not include a treatment plan for these prescribed psychotropic medications.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-320-B
Complaint related:	No
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure a risk assessment for tuberculosis (TB) was completed annually for one of three records reviewed. Evidence: 1. On 10-30-23, resident #1?s record did not include documentation of a current tuberculosis (TB) assessment. The TB documents in the record were dated 1-15-21 and 1-11-22. Resident?s date of admit noted as 9-15-20.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-380-B
Complaint related:	No
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure the personal and social information required in subsection 380-A of the regulations was kept current for one of three records reviewed. Evidence: 1. On 10-30-23, resident #3?s personal and social information document noted in the advance directive section, the resident had a Do Not Resuscitate (DNR). The allergy section noted the resident did not have any allergies. The resident?s physical examination document dated 8-21-23 noted resident?s allergy. The resident?s individualized service plan (ISP) dated 8-24-23 noted resident allergy to Citalopram, Erythromycin, Hydrocodone, Avelox, and Lyrica. The record did not include a signed and dated DNR document. The resident?s date of admit was noted as 8-24-23.
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 the resident?s comprehensive individualized service plan (ISP) included all assessed needs for one of three records reviewed. Evidence: 1. On 10-30-23, resident #3?s individualized service plan (ISP) dated, 8-21-23 documented resident was assessed as a Do Not Resuscitate (DNR). The ISP noted ?life saving measures WILL NOT be performed in the event of a cardiac or respiratory event?. The record included a copy of a blank DNR form. There was no documentation of a signed DNR document in the resident?s record. The resident?s date of admit noted as 8-24-23. 2. Staff acknowledged the resident?s record did not include a signed and dated DNR document.
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 resident?s individualized service plan (ISP) was reviewed and updated at least once every 12 months and as needed for a significant change of a resident's condition for one of three records reviewed. Evidence: 1. 10-30-23, resident #1?s individualized service plan (ISP) in the record was last updated on 8-24-22. The resident?s date of admit noted as 9-15-20. 2. Staff #1 acknowledged the resident?s ISP was not review and or updated.
Plan of Correction:	Not available online. Contact Inspector for more information.