VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Chesapeake Place
1500 & 1508 Volvo Parkway
Chesapeake, VA 23320
(757) 548-0808

Current Inspector: Donesia Peoples (757) 353-0430

Inspection Date: Feb. 1, 2024 and Feb. 21, 2024

Complaint Related: Yes

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 ? 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENT 22VAC40-80 COMPLAINT INVESTIGATION

Comments:

Type of inspection: Complaint An unannounced complaint inspection took place on 02/01/24 from 9:40 am to 2:30 pm and 02/21/24 from 1:37 pm to 2:30 pm. A complaint was received by the Division of Licensing on 01/17/24, 02/15/24, and 02/21/24 regarding allegations in the area(s) of: Resident Care and Related Services, Building and Grounds, and the Safe, Secure Environment. The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection Number of residents present at the facility at the beginning of the inspection: 72 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: 2 Number of interviews conducted with staff: 6 Observations by licensing inspector: Lunch and an activity were observed. The staffing schedule was reviewed. Additional Comments/Discussion: None An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation supported some, but not all of the allegation; area(s) of non-compliance with standard(s) or law were: Resident Care and Related Services, Buildings and Grounds, and The Safe Secure Environment. 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. 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 Donesia Peoples, Licensing Inspector at (757) 822-9957 or by email at donesia.peoples@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-1130-A
Complaint related:	Yes
Description:	Based on the onsite observation the facility failed to ensure except during night hours, when 20 or fewer resident are present, at least two direct care staff members shall be awake and on duty at all times in each special care unit who shall be responsible for the care and supervision of the residents. For every additional 10 residents, or portion thereof, at least one more direct care staff member shall be awake and on duty in the unit. Evidence: 1. During the onsite observation of the safe, secure unit on 02/21/24, the Licensing Inspector (LI) observed only one direct care staff member (staff #4) working in the safe, secure unit at the time of 1:38 p.m. Staff #4 confirmed to be the only direct care staff working in the safe, secure unit during the shift of 7am -3pm. 2. The facility?s census list dated 02/21/24 documented a total of 20 residents on site in the safe, secure unit. Staff #4 confirmed a total of 20 residents were on site in the safe, secure unit on 02/21/24.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-320-A
Complaint related:	No
Description:	Based on the record review the facility failed to ensure within the 30 days preceding admission, a person shall have a physical examination by an independent physician. The report of such examination shall be on file at the assisted living facility and shall contain the following: the signature of the examining physician or his designee. Evidence: 1. Resident?s #1 physical exam dated as completed on 09/18/23 does not include a signature of the examining physician or his designee. Staff #2 confirmed resident?s #1 physician exam did not include signature of the examining physician or his designee.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-450-E
Complaint related:	Yes
Description:	Based on the record review the facility failed to ensure the individualized service plan (ISP) shall be signed and dated by the licensee, administrator, or his designee, and by the resident or his legal guardian. Evidence: 1. Resident?s #1 ISPs dated 10/30/23 and 11/28/23 was not signed and dated by the resident or the legal guardian.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-450-H
Complaint related:	Yes
Description:	Based on the record review the facility failed to ensure that personal assistance and care are provided to each resident as necessary so that the needs of the resident are met, including assistance or care with: The activities of daily living: Bathing at least twice a week, but more often if needed or desired. Evidence: 1. Resident?s #2 Uniform Assessment Instrument (UAI) dated 07/28/23 documents the resident needs mechanical and human help (supervision) with bathing. Resident?s #2 ISP documents the following: ?staff will provide verbal cues for use of handrails during transfers while resident bathes.? Resident?s #2 activities daily log for Jan. 2024 does not include documentation of the resident receiving assistance with bathing the dates of 01/06/24 through 01/31/24.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-930-D
Complaint related:	Yes
Description:	Based on the record review the facility failed to ensure for each resident with an inability to use the signaling device the following shall be met: once the resident has gone to bed each evening until the resident has arisen each morning, at a minimum direct care staff shall make rounds no less than every two hours; the facility shall document the rounds that were made, which shall include the name of the resident, the date and time of the rounds, and the staff member who made the rounds. The documentation shall be retained at the facility for two years. Evidence: 1. Residents #1, and #2 ISPs documents the following: ?Resident will be checked on every 2 hours, resident unable to acclimate to use of call bell.? The record for residents #1, #2, did not include documentation of the time rounds were made during the shifts of 3pm -11pm and 11pm and 7 am for the month of Jan. 2024.
Plan of Correction:	Not available online. Contact Inspector for more information.