VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Commonwealth Senior Living at Williamsburg
236 Commons Way
Williamsburg, VA 23185
(757) 564-4433

Current Inspector: Willie Barnes (757) 439-6815

Inspection Date: Dec. 5, 2023 , Jan. 31, 2024 , Feb. 16, 2024 and Feb. 22, 2024

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES 22VAC40-73 PERSONNEL 22VAC40-73 BUILDINGS AND GROUND 22VAC40-80 COMPLAINT INVESTIGATION

Comments:

Type of inspection: Complaint An on-site inspection was conducted on 12-5-23 (Ar 10:00/ dep 4:45 p.m.) The facility census was 53. 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 10-2-23 and 10-3-23 regarding allegations in the area of staffing and supervision, food service and signaling and call systems. Number of residents present at the facility at the beginning of the inspection: 53 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: 0 Number of staff records reviewed: 0 Number of interviews conducted with residents: 2 Number of interviews conducted with staff: 12 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 were 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 #:	22VAC40-73-290-A
Complaint related:	No
Description:	Based on documents reviewed and staff interviewed, the facility failed to ensure the written work schedule included the names and job classification of all staff working each shift, with an indication of whomever is in charge at any given time. Evidence: 1. On 12-5-23, the written schedules for the nursing and dietary department noted the first name of staff scheduled. The written schedules did not include an indication of whomever was in charge at any given time. 2. Staff #1 acknowledged the written work schedules did not include all required information.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-610-B
Complaint related:	Yes
Description:	Based on observation and document reviewed, the facility failed to ensure the menus for meals and snacks for the current week was dated and posted in an area conspicuous to residents. Evidence: 1. On 12-5-23, the daily menu posted near the entrance to the dining area was dated 12-4-23. The weekly menu (Sunday thru Saturday) posted did not include snacks for the week. 2. Staff #11 acknowledged the menu posted was not the current menu for the day and the snacks were not included on the weekly menu.
Plan of Correction:	Not available online. Contact Inspector for more information.