VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Riverside Assisted Living at Sanders
7407 Walker Avenue
Gloucester, VA 23061
(757) 693-2000

Current Inspector: Darunda Flint (757) 807-9731

Inspection Date: Nov. 13, 2024 and Nov. 14, 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 BACKGROUND CHECKS FOR ASSISTED LIVING FACILITIES 22VAC40-90 THE SWORN STATEMENT OR AFFIRMATION 22VAC40-90 THE CRIMINAL HISTORY RECORD REPORT

Technical Assistance:

22VAC40-73-950-A-1-2

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: ( 11/13/2024 arrival 10:02 am / departure 2:35 pm) and (11/14/2024 arrival 9:52am / departure 2:11pm) 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: 31 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 4 Number of interviews conducted with residents: 3 Number of staff records reviewed:3 Number of interviews conducted with staff: 2 Observations by licensing inspector: Lunch was observed. A medication pass observation was completed for 3 residents. The following were reviewed: resident and staff records, medication carts, call bells, first aid kit, and water temperatures. An exit meeting will be conducted to review the inspection findings. 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 Darunda Flint, Licensing Inspector at (757) 807-9731 or by email at Darunda.a.flint@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-310-B
Description:	Based on record review and staff interviewed, the facility failed to ensure prior to admission of a resident, the facility administrator provided written assurance to the resident that the facility has the appropriate license to meet the care needs at the time of admission. Acknowledgement of this document should be signed by the resident or a legal representative and kept in the resident?s record. Evidence: 1. Residents #3?s record did not contain a signed and dated written assurance by the resident or the resident?s representative. 2. Residents #4?s record did not contain a dated written assurance by the resident or the resident?s representative. 3. Staff #1 acknowledged the files did not contain a signed and/or dated written assurance.
Plan of Correction:	1. AL Director will meet with residents 3 and 4 on 12/3/24 to review the Written Assurance and have it signed. 2. All charts will be audited to ensure that a Written Assurance has been reviewed, signed, dated and filed in chart. 3. The Administrator/designee will review the regulation and the process established for compliance of the Written Assurance notice with the assisted living director and team. 4. AL Director/Designee will audit all new admissions for a completed Written Assurance for eight weeks. The results of the audit will be reported at the QA meeting for evaluation and compliance. 5. All corrective actions will be completed by 12/15/2024
Standard #:	22VAC40-73-410-A
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure the record included an acknowledgement of the resident having received an orientation and the acknowledgment signed and dated by the resident, and as appropriate the legal representative and kept in the resident?s record. Evidence: 1. Resident #3?s record did not include documentation of an orientation for new residents which included information regarding mealtimes, the use of the call system, and the emergency response procedures. 2.Staff #1 acknowledged resident #3?s record did not contain proof that the resident received orientation. 3. Resident #4?s record did not include an orientation document that was dated by the resident, or their appropriate legal representative. 4. Staff #1 acknowledged resident #4?s orientation document was not dated by the resident, or their appropriate legal representative.
Plan of Correction:	1. AL Director met with residents 3 and 4 on 12/3/24 to review the Orientation Checklist and have it signed. 2. All charts will be audited to ensure that the Orientation Checklist has been completed and filed in chart. 3. AL Director will implement an audit on new admission documentation to ensure required documentation is complete. 4. AL Director/Designee will audit all new admissions for documentation of Orientation for eight weeks. The results of the audit will be reported at the QA meeting for evaluation and compliance. 5. All corrective actions will be completed by 12/15/2024
Standard #:	22VAC40-73-440-B
Description:	Based on record review, the facility failed to ensure for private pay individuals, the administrator or the administrator's designated representative approves and then signs the completed UAI. Evidence: 1. Resident #3?s UAI dated 03/20/2024 did not contain a signature of the administrator or administrator?s designee. 2. Staff #1 acknowledged the aforementioned residents? UAI was not completed as required.
Plan of Correction:	1.The Administrator signed the UAI identified for resident #3 on 11/15/2024. 2. All charts will be audited to ensure that all UAIs have been signed by the Administrator or designee. 3.New or revised UAIs will be audited monthly by LPN to validate they contain required signatures. 4. AL Director/Designee will audit all new admission UAIs to ensure Administrator signature is present for eight weeks. The results of the audit will be reported at the QA meeting for evaluation and compliance. 5. All corrective actions will be completed by 12/15/2024
Standard #:	22VAC40-73-450-E
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure the individualized service plan (ISP) shall be signed and dated by the licensee, administrator or designee and the resident or legal representative. Evidence: 1. On 11/14/2024 resident #3?s ISP, with an initiated date of 03/26/2024, did not include the date the resident and/or legal representative signed the ISP. 2. Staff #1 acknowledged the aforementioned residents? ISP was not dated by the resident and/or representative.
Plan of Correction:	1. Resident # 3 ISP was signed and dated on 3/25/24. 2. All charts will be audited to ensure that all ISPs have been signed and dated by the resident or resident representative. 3. Administrator/designee will review the regulation, and the process established for compliance of the ISP being signed and dated by the resident and/or representative with the assisted living director and clinical team. 4. AL Director/Designee will audit all newly completed ISPs for resident or resident representative signatures and dates for eight weeks. The results of the audit will be reported at the QA meeting for evaluation and compliance. 5.All corrective actions will be completed by 12/15/2024
Standard #:	22VAC40-73-640-A
Description:	Based on observation, the facility failed to implement their methods to prevent the use of outdated medications based off their written plan for medication management. Evidence: 1. The following expired medications were observed on the medication carts at the facility: Guaifenesin Soln 100mg/5ml to be discarded on 11/02/2024 or sooner for resident #1 and Meclizine 25 mg tablets expired 09/21/2024. 2. Staff #6 acknowledge the aforementioned resident?s medications were expired.
Plan of Correction:	1. The expired medications were removed immediately from the cart on 11/13/24. 2. All carts were audited for expired medications by the director of assisted living /designee on 11/18/2024, and none were found. 3. AL Director/Designee will educate the clinical staff on checking dates on medications daily to ensure that medications are removed from the cart prior to expiration. 4. AL Director/Designee will audit the carts weekly for expired medications for eight weeks to ensure no expired medications are present. The results of the audit will be reported at the QA meeting for evaluation and compliance. 5. All corrective actions will be completed by 12/15/2024
Standard #:	22VAC40-73-860-G
Description:	Based on observation and staff interviewed, the facility failed to ensure the hot water at taps available to residents shall be maintained within a range of 105 degrees Fahrenheit (F) to 120 degrees F. Evidence: 1.On 11/13/2024 during a tour of facility with staff #1, the hot water temperature was checked in room #201. The temperature reading was 121.6 degrees F. 2.On 11/13/2024 during a tour of facility with staff #1, the hot water temperature was checked in room #102. The temperature reading was 120.6 degrees F. 3.Staff #1 acknowledged the water temperature was not within the required
Plan of Correction:	1.The Facilities Director on 11/13/24 immediately adjusted the hot water heater to bring water temperature down to 115. 2. Water temperature will be checked daily by the Assisted Living Director in the various water heater zones throughout the building to ensure that the temperatures remain within the range of 105-120. 3. The Director of Assisted Living /designee reviewed the regulatory temperature ranges with the Director of Maintenance 4. Maintenance Director will audit three apartments weekly for water temperature ranges for eight weeks. The results of the audit will be reported at the QA meeting for evaluation and compliance. 5. All corrective actions will be completed by 12/15/2024
Standard #:	22VAC40-73-960-B
Description:	Based on observation and staff interviewed, the facility failed to ensure there was a fire and emergency evacuation drawing posted in a conspicuous place on each floor of each building used by residents. The drawing shall show primary and secondary escape routes, areas of refuge, assembly areas, telephones, fire alarm boxes and fire extinguishers, as appropriate. Evidence: 1. On 11/13/2024 during a tour of the facility, the posting located at the front door did not include a secondary escape route, the area of refuge, the area of assembly, fire alarm boxes and fire extinguishers and telephone locations 2. On 11/13/2024 during a tour of the facility, the posting located next to the first-floor elevator did not include the area of refuge. 3. On 11/13/2024 during a tour of the facility, the posting located on the second floor did not include a secondary escape route, the area of refuge, the area of assembly, 4. Staff #1 acknowledge the posted plans did not include all of the regulatory requirements
Plan of Correction:	Not available online. Contact Inspector for more information.