VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Fort Shelby Manor
200 Solar Street
Bristol, VA 24201
(276) 669-3562

Current Inspector: Rebecca Berry (276) 608-3514

Inspection Date: April 4, 2024

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 PERSONNEL 22VAC40-73 RESIDENT ACCOMMODATIONS AND RELATED PROVISIONS 22VAC40-73 BUILDINGS AND GROUND

Comments:

Type of inspection: Complaint Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 04/04/2024 2:52pm to 3:42pm 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 02/28/2024 regarding allegations in the area(s) of: Personnel, building and grounds. Number of residents present at the facility at the beginning of the inspection: 37 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: N/A Number of staff records reviewed: 0 Number of interviews conducted with residents: 3 Number of interviews conducted with staff: 1 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 allegation(s); area(s) of non-compliance with standard(s) or law were: Building and grounds, resident accommodations and related provisions. A violation notice was issued; any violation(s) not related to the complaint(s) 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 Becky Berry, Licensing Inspector at 276-608-3514 or by email at rebecca.berry@dss.virginia.gov.

Violations:

Standard #:	22VAC40-73-750-E
Complaint related:	No
Description:	Based on observations made during a tour of the building, the facility failed to have sufficient bed and bath linens in good repair so that residents always have clean sheets and pillowcases. EVIDENCE: 1. Several small dark spots were observed on the sheets, pillow and pillowcase for resident #3 at the time of inspection.
Plan of Correction:	Staff have been reminded to follow the cleaning schedule which is to change and wash linens weekly and more if needed to ensure that residents have clean linens at all times. [SIC]
Standard #:	22VAC40-73-870-D
Complaint related:	Yes
Description:	Based on observations made during a tour of the building and interviews with residents and staff, the facility failed to ensure buildings shall be kept free of infestations of insects and vermin. EVIDENCE: 1. The licensing inspector (LI) observed a live and crawling bed bug on the bed for resident #4 in the men?s house on the date of inspection. 2. Resident #1 and resident #2 confirmed the presence of bed bugs in the men?s house on the date of inspection. Resident #2 presented a piece of clear tape with several dead bed bugs attached. 3. Staff #1 confirmed an ongoing bed bug infestation in both the men?s and women?s houses. She confirmed receipt of ongoing monthly pest control services to treat the infestation.
Plan of Correction:	Staff are to check each bed daily for any live or dead bedbugs and report to the administrator. Staff then have access to spray to use for that time. Affordable Pest Control comes monthly to treat the facility for bed bugs. The administrator has been in touch with Dini Miller at Virginia Tech and invited her to come and share anything to help with the situation. We are open to any help. [SIC]