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: Jan. 28, 2025

Complaint Related: No

Areas Reviewed:

22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES 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

Comments:

Type of inspection: Monitoring Dates of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 1/28/25 2:30pm to 3:40 pm The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. 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 interviews conducted with residents: 1 Number of interviews conducted with staff: 1 Observations by licensing inspector: medication administration, resident rooms, file documentation, facility maintenance and repair, snacks Additional Comments/Discussion: Follow-up completed on non-compliance found at renewal inspection on 10-28-24 An exit meeting was conducted to review the inspection findings. The evidence gathered during the inspection determined non-compliance with applicable standards or law, violations are 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) 662-7454 or 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. Non-compliance with this standard was previously found at the renewal inspection in October 2024.
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 file for resident # 1. The administrator stated there was no documented interview in the file. Non-compliance with this standard was previously found at the renewal inspection in October 2024.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-320-A
Description:	Based on file reviews, the facility did not ensure that within 30 days preceding admission, a person have a physical examination by an independent physician that contains the results of a risk assessment documenting the absence of in a communicable form. Evidence: The documented date of admission for resident # 1 was 9/12/24, the tuberculosis screening is dated 9/1/23 (one year prior to admission).
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 file for resident# 1. The administrator agreed that there was no documented screening. Non-compliance with this standard was previously found at the renewal inspection in October 2024.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-390-A
Description:	Based on file reviews, the facility did not ensure that at or prior to the time of admission there shall be a written agreement or acknowledgement of notification of an agreement with the required elements. Evidence: The written agreement in the file for resident # 1 contained two of four required pages (the first and last page).
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-440-G
Description:	Based on file reviews, the facility did not ensure that the uniform assessment instrument (UAI) shall be completed when the previous assessment is more than 12 months old. Evidence: The documented date of admission for resident # 1 was 9/12/24, the UAI is dated 5/8/23 (more than 12 months old).
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, staff shall document on a medication administration record (MAR) all medications administered to residents, including over-the- counter medications and dietary supplements. Evidence: The administrator reported that there were no documented MARS available for review for the 10 residents in care. Non-compliance with this standard was previously found at the renewal inspection in October 2024.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-870-A
Description:	Based on observation, the facility did not ensure that the interior and exterior of all buildings shall be maintained in good repair and kept clean and free of rubbish. Evidence: One bedroom (1st floor at entrance) had a discolored floor with pieces of a disassembled bed and clothes in untidy piles scattered around the room.
Plan of Correction:	Not available online. Contact Inspector for more information.