VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Cana Adult Home
2004 Wards Gap Road
Cana, VA 24317
(276) 755-4338

Current Inspector: Holly Copeland (540) 309-5982

Inspection Date: Feb. 29, 2024

Complaint Related: No

Areas Reviewed:

22VAC40-73 GENERAL PROVISIONS 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 22VAC40-73 RESIDENT ACCOMMODATIONS AND RELATED PROVISIONS 22VAC40-73 BUILDINGS AND GROUND 22VAC40-73 EMERGENCY PREPAREDNESS 22VAC40-90 THE SWORN STATEMENT OR AFFIRMATION 22VAC40-90 THE CRIMINAL HISTORY RECORD REPORT

Comments:

Type of inspection: Renewal Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 02/29/2024 from 09:00 AM until 01:15 PM The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. The evidence gathered during the inspection determined non-compliance with applicable standard(s) or law, and violation(s) were documented on the violation notice issued to the facility. 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 #:	22VAC40-73-250-D
Description:	Based on record review and staff interview, the facility failed to ensure that staff annually submitted the results of a risk assessment, documenting that the individual is free of tuberculosis (TB) in a communicable form as evidenced by the completion of the current screening form published by the Virginia Department of Health, or a form consistent with it. EVIDENCE: 1. The records for staff 1, staff 2, and staff 3 each contained a Virginia Department of Health - Report of Tuberculosis Screening form which indicated that TB screenings were last completed on staff 1, staff 2, and staff 3 on 12/12/2022; however, LI could not locate evidence that any TB screenings or tests were completed for those staff members in 2023. 2. An interview with staff 4 revealed that the facility failed to complete the annual TB screenings or tests for staff for 2023.
Plan of Correction:	Administrator will coordinate with health department to ensure TB tests are performed in a timely manner.
Standard #:	22VAC40-73-320-B
Description:	Based on record review and staff interview, the facility failed to ensure that a risk assessment for tuberculosis (TB) shall be completed annually on each resident as evidenced by the completion of the current screening form published by the Virginia Department of Health or a form consistent with it. EVIDENCE: 1. The records for resident 3, resident 4, resident 5, and resident 6 each contained a Virginia Department of Health - Report of Tuberculosis Screening form which indicated that TB screenings were last completed on resident 3, resident 4, resident 5, and resident 6 on 12/12/2022; however, LI could not locate evidence that any TB screenings or tests were completed for those residents in 2023. 2. An interview with staff 4 revealed that the facility failed to complete the annual TB screenings or tests for residents for 2023.
Plan of Correction:	Administrator will coordinate with health department to ensure TB tests are performed in a timely manner.
Standard #:	22VAC40-73-940-A
Description:	Based on record review and staff interview, the facility failed to ensure compliance with the Virginia Statewide Fire Prevention Code by having at least an annual inspection by the appropriate fire official. EVIDENCE: 1. Facility documentation indicated that the last documented fire inspection by the fire marshal occurred on 08/15/2022; however, LI could not locate evidence that an annual fire inspection occurred in 2023. 2. An interview with staff 4 revealed that the facility cannot provide evidence that a 2023 fire inspection had occurred.
Plan of Correction:	Administrator will ensure documentation is obtained when inspections are performed.