VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Alpha House I
4526 Brickwood Meadow Ct.
Petersburg, VA 23803
(804) 861-0596

Current Inspector: Irvin Goode (804) 543-5188

Inspection Date: Jan. 14, 2021 , Jan. 19, 2021 , Feb. 4, 2021 , Feb. 5, 2021 , Feb. 10, 2021 and Feb. 23, 2021

Complaint Related: No

Areas Reviewed:

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

Technical Assistance:

Discussed date of employment for each position held and separation as noted in 240.B6. Discussed other policies and procedures that are applicable to their positions, duties, and responsibilities in relation to orientation and training as noted in 250.A.3.e.

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 1/14/21 and concluded on 2/23/21. The Program Director was contacted by telephone on 1/14/21 to initiate the inspection. The Program Director reported that the current census was four (4) 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 two resident records. Reviewed health care and medication administration records. Four personnel records were reviewed. No discrepancies were found with the CRF matrix. The Program Director was interviewed on 2/4/21, 2/5/21, and 2/10/21. 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 #:	22VAC40-151-610-3
Description:	Violation: Based upon review of the current resident?s, CR1, record and interview with staff, the facility failed to clearly document in written assessment information gathered for the emergency admission that the individual meets the facility?s criteria for admission. Findings: 1. CR1 was admitted on 4/15/20 as an emergency admission. 2. There was no clear documentation in written assessment information gathered for the emergency admission that confirmed CR1 met the facility?s criteria for admission. 3. The Licensing Specialist asked S5 if she clearly documented this particular information. 4. S5 confirmed the documentation had not been completed by stating the following- ?I did not write that CR1 meets criteria for the (emergency) admission.?
Plan of Correction:	Director shall document on application that residents admitted on emergency circumstances meets criteria for admission to Alpha House on the application for admission effective immediately.
Standard #:	22VAC40-151-620-C
Description:	Violation: Based upon review of the current resident?s, CR1, record and interview with staff, the facility failed to ensure the resident?s record contained a completed application for admission at the time of admission or within 30 days after an emergency admission. Findings: 1. CR1 was admitted on 4/15/20 as an emergency admission. 2. CR1?s admission application signed by the placing agency on 4/13/20 was incomplete. Certain elements on the application were missing information or blank including ?Immunization needed.? 3. The Licensing Specialist interviewed S5 who acknowledged the application was not complete within 30 days after CR1?s emergency admission. S5 also stated the following ? ?I did not go back to update the application within 30 days.?
Plan of Correction:	Director did obtain a copy of the CR1 immunization record within 30 days of admission to determine resident needs but director did not document this information on the admission application. Director shall in the future add information to the admission application as it obtained for admissions.
Standard #:	22VAC40-151-1010-B
Description:	Violation: Based upon review of the staff records and interview with staff, the facility failed to ensure each direct care worker had certification in infant CPR and First Aid prior to working alone with infants and toddlers. Findings: 1. Staff, S1 ? a. On 1/21/21, S5 submitted a copy of an American Red Cross card, which shows S1 obtained certification for Adult CPR/AED, Child CPR and First Aid. b. This document shows that S1 is not certified in CPR and First Aid as it pertains to infants and toddlers. c. According to the American Red Cross? website, S1 should have completed the requirements and obtained certification for Adult and Pediatric First Aid/CPR/AED. The website defines adult as ?about 12 years and older? and pediatric as ?infants and children up to 12 years of age.? d. The Licensing Specialist interviewed S5 about S1?s certification on 2/4/21. S5 acknowledged the infant certification was not on the American Red Cross document for S1. e. On 2/8/21, S5 submitted a copy of an American Red Cross card, which shows S1 obtained certification for Adult and Pediatric First Aid/CPR/AED on 2/7/21. f. The Licensing Specialist interviewed S5 on 2/10/21 and confirmed S1?s current certification. 2. Staff, S2 ? a. On 1/21/21, S5 submitted a copy of an American Red Cross document, which shows S2 obtained certification for Adult CPR/AED, Child CPR and First Aid. b. This document shows that S2 is not certified in CPR and First Aid as it pertains to infants and toddlers. c. According to the American Red Cross? website, S1 should have completed the requirements and obtained certification for Adult and Pediatric First Aid/CPR/AED. The website defines adult as ?about 12 years and older? and pediatric as ?infants and children up to 12 years of age.? d. The Licensing Specialist interviewed S5 about this matter on 2/4/21. S5 acknowledged the infant certification was not on the American Red Cross document for S2.
Plan of Correction:	The director will review and ensure all First Aid/CPR training received by staff clearly states that staff have been trained in training to meet all ages of residents served at Alpha House immediately.