VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Henry and William Evans Home
330 East Leicester Street
Winchester, VA 22601
(540) 662-8520

Current Inspector: Kevin Lassiter (804) 241-2093

Inspection Date: Jan. 15, 2021 , Jan. 19, 2021 , Feb. 3, 2021 , Feb. 5, 2021 , Feb. 8, 2021 and Feb. 23, 2021

Complaint Related: No

Areas Reviewed:

22VAC40-151 22VAC40-151 PROGRAMS AND SERVICES 22VAC40-151 DISASTER OR EMERGENCEY PLANNING

Technical Assistance:

None

Comments:

This inspection was conducted by the licensing staff using an alternate remote protocol, necessary due to a state of emergency health pandemic declared by the Governor of Virginia. A monitoring inspection was initiated on 1/15/21 and concluded on 2/23/21. The Program Director was contacted by telephone on 1/15/21 to initiate the inspection. The Program Director reported that the current census was six (6) residents. The Licensing Specialist emailed the Program Director a list of items required to complete the inspection. The following is a listing of the activities for this inspection: Reviewed one current resident record. Reviewed health care and medication administration records. Two personnel records were reviewed. No discrepancies were found with the CRF matrix. The Program Director was interviewed on 2/8/21. Other documentation reviewed during this inspection included, but was not limited to the following: emergency drill documentation, staff work schedules, and daily log book entries. Upon receipt of this violation notice, a plan of correction is requested for each violation. The Plan of Correction should include, as appropriate: - steps to correct noncompliance of a regulation, - measures to prevent reoccurrence of noncompliance, - person(s) responsible for implementing each step and/or monitoring any preventive measure(s), and - the date by which the noncompliance will be corrected. Be advised that the Violation Notice, including the Plan of Correction and this Summary page will be posted on the VDSS web page and available for review by the general public. Do not write any names or other confidential information into your plan of correction.

Violations:

Standard #:	22VAC40-151-660-H-2
Description:	Violation: Based upon review of the current resident?s, CR1?s, record and interview with staff, the facility failed to involve the resident?s family in the development of the quarterly progress report. Findings: 1) The final page of the quarterly progress report (QPR) dated for 11/30/20 lists the parties who participated in the development of this document. 2) The element for the resident?s family as it pertains to the development of the QPR is missing. 3) The ?Family Involvement? section of the QPR shows that CR1?s mother interacts with CR1 since the goal is to return home. 4) Staff, S3, was asked about this particular element and acknowledged this element was missing from the QPR.
Plan of Correction:	From this point forward, S3, will involve the residents family members, regardless of who has legal custody, in the development of the quarterly progress reports, unless the legal guardian has provided a reason for which the residents family should not be involved. This reason must be submitted in writing and included in the residents file.
Standard #:	22VAC40-151-660-I
Description:	Violation: Based upon review of the current resident?s, CR1?s, record and interview with staff, the facility failed to distribute the quarterly progress report to the resident?s family. Findings: 1) The final page of the quarterly progress report (QPR) dated for 11/30/20 lists the parties who received a copy of this document. 2) The element for the resident?s family as it pertains to receiving a copy of QPR is missing. 3) The ?Family Involvement? section of the QPR shows that CR1?s mother interacts with CR1 since the goal is to return home. 4) Staff, S3, was asked about this particular element and acknowledged this element was missing from the QPR.
Plan of Correction:	From this point forward, S3, will distribute a copy of the progress report to the residents family members, regardless of who has legal custody, unless the legal guardian has provided a reason for which the residents family should not receive a copy of the progress report. This reason must be submitted in writing and included in the residents file.