VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Dogwood Crossing Senior Living And Memory Care
130 Deer Ridge Trail
Tazewell, VA 24651
(276) 385-7150

Current Inspector: Rebecca Berry (276) 608-3514

Inspection Date: June 4, 2025 and June 5, 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 SERVICES 22VAC40-73 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 22VAC40-90 THE SWORN STATEMENT OR AFFIRMATION 22VAC40-90 THE CRIMINAL HISTORY RECORD REPORT

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: 06/04/2025, 10:10am to 3:07pm and 06/05/2025, 9:45am to 1:32pm 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: 46 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 5 Number of staff records reviewed: 3 Number of interviews conducted with residents: 2 Number of interviews conducted with staff: 3 Observations by licensing inspector: Noon meal, activities, medication pass Additional Comments/Discussion: 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 Becky Berry, Licensing Inspector at 276-608-3514 or by email at rebecca.berry@dss.virginia.gov.

Violations:

Standard #:	22VAC40-73-450-C
Description:	Based on a review of resident records, the facility failed to ensure that the comprehensive individualized service plan shall contain all required information. EVIDENCE: 1. The uniform assessment instrument (UAI) for resident #1 dated 12/15/2024 describes resident #1 as disoriented, some spheres, all of the time (place and time). The comprehensive individualized service plan (ISP) for resident #1 dated 12/15/2024 describes services to be provided as ?Staff to report any issues.? A detailed written description of what services will be provided to address this identified need is not included on the ISP. 2. The UAI for resident #2 dated 03/02/2025 describes resident #2 as disoriented, some spheres, some of the time (place and time). The section of the comprehensive ISP for resident #2 dated 03/02/2025 addressing services to be provided states ?Resident is oriented to self only, disoriented to time and place some of the time.? A written description of what services will be provided to address this identified need is not included on the ISP. 3. The UAI for resident #4 dated 05/19/2025 describes resident #4 as disoriented, some spheres, some of the time (disoriented to time occasionally). The comprehensive ISP for resident #4 dated 05/19/2025 describes services to be provided as ?Disoriented to time some of the time? and expected outcomes are described as ?Resident?s orientation status will be monitored, and staff will report changes.? A detailed written description of what services will be provided to address this identified need is not included on the ISP.
Plan of Correction:	Facility Administrator and RCD will review UAI?s and ISP?s to address identifying a detailed description for all services provided on ISP?s. [SIC]