VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Sunrise on the South Home Care & Transportation
3000 South Street
South chesterfield, VA 23834
(804) 490-8899

Current Inspector: Yvonne Randolph (804) 441-1180

Inspection Date: Oct. 28, 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

Comments:

Type of inspection: Renewal Date of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 10/28/24 4pm to 5:15pm 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: 10 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 2 Number of staff records reviewed: 2 Number of interviews conducted with residents: 1 Number of interviews conducted with staff: 1 Observations by licensing inspector: file documentation, facility maintenance and upkeep, dinner meal, resident rooms, staff/resident interaction An exit meeting was conducted to review the inspection findings. The evidence gathered during the inspection determined non-compliance with applicable standards or law, and violations 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 violations will be addressed in order to return the facility to compliance and maintain future compliance with applicable standards 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) 662-7454or by email at yvonne.randolph@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-50-A
Description:	Based on file reviews, the facility did not ensure that the disclosure statement shall be on a form developed by the department. Evidence: The disclosure statement in the files for residents # 1 and # 2 was not the most recent disclosure statement developed by the department (10/19). The administrator agreed that the form used was not the current form developed by the department.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-310-B
Description:	Based on file reviews and an interview, the facility did not ensure a documented interview prior to admission between the administrator or a designee responsible for admission and the individual, and his legal representative, if any. Evidence: A documented interview was not in the files for residents # 1 and # 2. The administrator stated that there was no documented interview in the files.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-350-B
Description:	Based on file reviews and an interview, the facility did not ascertain, prior to admission, whether a potential resident is a registered sex offender and document in the resident's record that this was ascertained and the date the information was obtained. Evidence: A sex offender screening was not found in the files for residents # 1 and # 2. The administrator agreed that there was no documented screening.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-450-B
Description:	Based on file reviews, the facility did not ensure that the licensee, administrator, or his designee who has successfully completed the department-approved individualized service plan (ISP) training, provided by a licensed health care professional practicing within the scope of his profession, shall develop a comprehensive ISP to meet the resident's service needs. Evidence: The individualized service plans for residents # 1 and # 2 were completed by staff # 3. The administrator did not provide documentation of completion of the department approved individualized service plan training by staff # 3.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-680-H
Description:	Based on an interview, the facility did not ensure that at the time medication is administered, the facility shall document on a medication administration record (MAR) all medications administered to residents, including over-the- counter medications and dietary supplements. Evidence: MARs were not available or provided for review. The administrator reported that there were no documented MARS for the 10 residents in care.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-900
Description:	Based on observation, the facility did ensure that there shall be no more than two residents residing in a bedroom. Evidence: Three beds were observed in the front downstairs bedroom. The administrator was shown the bedroom and stated that there were three residents residing in the bedroom.
Plan of Correction:	Not available online. Contact Inspector for more information.