VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Essex House
17976 Tidewater Trail
Tappahannock, VA 22560
(804) 443-5921

Current Inspector: Yvonne Randolph (804) 662-7454

Inspection Date: Feb. 27, 2024

Complaint Related: No

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

Comments:

Type of inspection: Monitoring Date the licensing inspector was on-site at the facility for each day of the inspection: 2/27/24 The Acknowledgement of Inspection form was emailed for each date of the inspection. A self-reported incident was received by VDSS Division of Licensing on 2/16/24 in the area of : Resident Care and Related Services Number of residents present at the facility at the beginning of the inspection: 20 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 1 Number of staff records reviewed: 0 Number of interviews conducted with residents: Number of interviews conducted with staff: 1 An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation supported non-compliance with standard(s) or law, and violation(s) were issued. Any violation(s) not related to the self-report 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 Yvonne Randolph, Licensing Inspector at 804-662-7454 or by email at yvonne.randolph@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-70-A
Description:	Based on a file review, the facility did not 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. A self-report was received by the Central Region licensing office on 2-16-24 that a resident was discovered missing on 2-13-24. 2. The report was not received within 24 hours of the incident.
Plan of Correction:	Will report all incidents that have a negative affect or that threatens the life, health, safety or welfare of any resident within 24 hours.
Standard #:	22VAC40-73-460-D
Description:	Based on a self-report, the facility did not provide supervision of resident schedules, care and activities, including attention to specialized needs, such as prevention of falls and wandering from the premises. Evidence: 1. The physical examination for resident # 1 dated 1/31/24 documents a diagnosis of dementia. 2. An Elopement Risk Rating document completed for resident # 1 at admission listed required interventions due to elopement risk as ?frequent monitoring? and ?exit alarms all in working order and checked each shift?. 3. Resident # 1 wandered from the facility and was discovered missing after: (1) staff # 1 received a telephone call at 11:45 pm on 2-13-24 of a man walking on the north side of the road near the facility and (2) a search of the building. 4. Staff # 2 reported that the exit door alarm had been turned off on 2-13-24 by staff # 1.
Plan of Correction:	All door alarms will be checked at the beginning of each shift by the RMA during their initial rounds beginning of each shift to ensure the alarms are activated and fully discharged. Extra batteries and door devices will be kept in the locked medical closet when needed. The daughter of resident # 1 was given a "Project Life Saver" from Essex County Sheriff Office o 2/29/24. Upon completion and return of this application, the Sheriff Office will be contacted to initiate this process. Notations have been posted to the 24 hour Communication Log that staff is to be aware of residents location at all times.