VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Greenfield Reflections of Woodstock
1222 S. Ox Road
Woodstock, VA 22664
(540) 459-2200

Current Inspector: Angela N Via (540) 682-1739

Inspection Date: April 7, 2025

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 SERVICE22VAC40-73 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 IMPAIRMENTS 63.2 GENERAL PROVISIONS 63.2 FACILITIES AND PROGRAMS 22VAC40-90 BACKGROUND CHECKS FOR ASSISTED LIVING FACILITIES 22VAC40-90 THE SWORN STATEMENT OR AFFIRMATION 22VAC40-90 THE CRIMINAL HISTORY RECORD REPORT

Technical Assistance:

None

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: 4/7/2025 9:30am ? 4:00pm 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: 26 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 staff records reviewed: 13 Number of interviews conducted with residents: 3 Number of interviews conducted with staff: 3 Observations by licensing inspector: The Licensing Inspector observed the residents during activities, meals and in their apartments. The following were reviewed at the time of inspection: Menus, activity calendars, fire drills, emergency drills, resident council minutes, dietician report, healthcare oversight. Additional Comments/Discussion: None 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 Jessica Gale, Licensing Inspector at 540-571-0358 or by email at Jessica.gale@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-1090-A
Description:	Based on record review and staff interview, the facility failed to ensure prior to his admission to a safe, secure environment, the resident was assessed by an independent clinical psychologist licensed to practice in the Commonwealth or by an independent physician as having a serious cognitive impairment due to a primary psychiatric diagnosis of dementia with an inability to recognize danger or protect his own safety and welfare. Evidence: 1. Resident 1 was admitted into a safe, secure environment on 11/7/2024. 2. Upon request, the facility did not provide an assessment of serious cognitive impairment for resident 1. 3. During an interview with staff 1, when asked if there was a serious cognitive impairment completed for resident 1, staff 1 stated ?no, we never got it."
Plan of Correction:	Potential Residents will have an Assessment of Serious Cognitive Impairment completed prior to admission
Standard #:	22VAC40-73-320-A
Description:	Based on record review and staff interview, the facility failed to ensure within the 30 days preceding admission, a person have a physical examination completed by an independent physician and the report of such examination be on file. Evidence: 1. Resident 1 admitted 11/7/2024, had a physical examination and report dated 11/18/2024. 2. During an interview with staff 1, when asked if resident 1 had a physical examination and report completed prior to admission, staff 1 stated ?no, we never got it.?
Plan of Correction:	Potential Residents will not be admitted to the facility if the physical examination has not been completed within 30 days prior to the admission date.
Standard #:	22VAC40-73-410-A
Description:	Based on record reviews and staff interview, the facility failed to ensure acknowledgment of having received an orientation that was signed and dated by the resident and, as appropriate, his legal representative, and kept in the resident's record. Evidence: 1. Record review for resident 1 admitted 11/7/2024, resident 2 admitted 11/21/2024 and resident 3 admitted 2/27/2025 did not have the resident orientation signed by the resident. 2. During an interview with staff 1, when asked if the resident orientation was signed by resident 1, 2, or 3, staff 1 stated ?no, I didn?t know the resident needed to sign them?.
Plan of Correction:	All Residents will sign the new resident orientation back on admission.
Standard #:	22VAC40-73-860-I
Description:	Based on direct observation the facility failed to store cleaning supplies and other hazardous materials in a locked area. Evidence: 1. This facility is a safe, secured environment only. 2. During the facility tour on 4/7/2025 completed with staff 1 the following cleaning supplies were stored in unlocked areas: - Two containers of disinfectant in the kitchenette cabinet - One container of Germicidal alcohol wipes in the cabinet by the main entry door. Five bottles of lotion and 3 bottles of wound cleanser solution in the cabinet by the main door. 2. Photo evidence taken.
Plan of Correction:	Education will be provided to all staff members informing them of the policy that requires all supplies to be kept in locked housekeeping closets.
Standard #:	22VAC40-73-870-A
Description:	Based on record review and staff interview, the facility failed to ensure the interior of all buildings was maintained and in good repair. Evidence: 1. During the facility tour on 4/7/2025 completed with staff 1, the carpet was torn and ripped in the entry common area and the back resident hallway, exposing the under layer of flooring. 2. Photo evidence taken.
Plan of Correction:	We have called Lowes, NVB Contracting, and K.R. Interiors to complete estimates to have the flooring replaced/fixed. The maintenance Director will replace carpeted in the areas that need replaced to prevent falls.
Standard #:	22VAC40-73-870-E
Description:	Based on record review and staff interview, the facility failed to ensure all furnishings, fixtures, and equipment was kept clean and in good repair and condition. Evidence: 1. During the facility tour on 4/7/2025, two dining room tables were observed with the top vinyl finish ripped and exposing the under layer of table. 2. Photo evidence taken.
Plan of Correction:	Table Clothes will be applied to all tables until new table tops arrive or the current ones are replaced.
Standard #:	22VAC40-73-970-A
Description:	Based on record reviews and staff interview, the facility failed to ensure fire and emergency evacuation drill frequency and participation was in accordance with the current edition of the Virginia Statewide Fire Prevention Code (13VAC5-51) with drills required for each shift in a quarter not conducted during the same month. Evidence: 1. During an interview with staff 1, staff 1 stated the shifts for the facility were 7-3 (first), 3-11 (second), and 11-7 (third). 2. Record review for fire drills indicated the following drills were completed, 1/15/2025, second shift, 12/12/2024, first shift, 11/22/2024, second shift, 10/30/2024, first shift, 9/20/2024, first shift, 8/22/2024, second shift, 7/18/2024, second shift, 6/20/2024, first shift, ' 5/23/2024, third shift.
Plan of Correction:	Fire Drills will be completed on each shift quarterly, no shift will have consecutive monthly fire drills.
Standard #:	22VAC40-90-30-B
Description:	Based on record review and staff interview, the facility failed to ensure a sworn statement or affirmation was completed for all applicants for employment. Evidence: 1. Record review of all new hires since the last inspection completed on 4/25/2024 showed the following sworn statements completed: - Staff 2 hired 7/22/2024, completed 7/28/2024 - Staff 3 hired 7/12/2024, completed 8/2/2024. - Staff 4 hired 10/4/2024, completed 10/17/2024. 2. During an interview with staff 1 when asked if the sworn statements were completed as required for staff 2, 3, and 4, staff 1 stated ?no they weren?t?.
Plan of Correction:	All new hires will complete the required paperwork prior to the start date with the company.
Standard #:	22VAC40-90-40-B
Description:	Based on record review and staff interview, the facility failed to ensure a criminal history record report (CHRR) was obtained on or prior to the 30th day of employment for each employee. Evidence: 1. Record review of all new hires since the last inspection completed on 4/25/2024 showed the following CHRR?s completed: ? Staff 2 hired 7/22/2024, completed 9/9/2024. ? Staff 3 hired 7/12/2024, completed 9/9/2024. ? Staff 5 hired 9/4/2024, completed 11/13/2024. ? Staff 6 hired 12/19/2024, completed 2/19/2025. ? Staff 7 hired 7/13/2024, completed 9/9/2024. ? Staff 8 hired 7/15/2024, completed 9/9/2024. ? Staff 10 hired 7/1/2024, completed 9/9/2024. 2. Upon request the facility did not provide a CHRR for staff 9. 3. During an interview with staff 1, when asked if a CHRR was completed for staff 9, staff 1 answered ?no?.
Plan of Correction:	All new hires will have completed CRHH prior to the start date or within 30 days of employment with the company.