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: Oct. 6, 2022 and Oct. 19, 2022

Complaint Related: No

Areas Reviewed:

22VAC40-151 Administration 22VAC40-151 Residential Environment 22VAC40-151 Programs and Services 22VAC40-151 Programs and Services 22VAC40-151 Disaster or Emergency Planning

Technical Assistance:

Discussed plumbing as noted in CRF standard 22 VAC 40-151-390.A. Discussed documentation of staff supervision as noted in CRF standard 22 VAC 40-151-260.3. Discussed security measures to protect records from loss, inadvertent or unauthorized access, and disclosure of information as noted in CRF standard 22 VAC 40-151-580.C.3. Discussed the application for admission as it pertains to physical health needs, including the immunization needs of the prospective resident as noted in CRF standard 22 VAC 40-151-620.B.3. Discussed the face sheet in the resident?s record as it pertains to race as noted in CRF standard 22 VAC 40-151-640.A. Distributed the Initial Objectives and Strategies as it pertains to it being distributed to affected staff and the resident as noted in CRF standard 22 VAC 40-151-650. Discussed the elements of the application for admission for the adolescent?s child as noted in CRF standard VAC 40-151-1010.D.1-3.

Comments:

Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 10/6/22 from 10:15 AM ? 5:40 PM, 10/7/22 from 10:02 AM ? 4:50 PM, and 10/12/22 from 10:01 AM ? 5:30 PM The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. Number of residents in care at the beginning of the inspection: 3 mothers and 3 babies The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident?s records reviewed: 2 Number of staff records reviewed: 3 Number of interviews conducted with residents: 1 Number of interviews conducted with staff: 1 Additional Comments/Discussion: An entrance meeting was held on 10/7/22. The Team Leader was accessible and available during the inspection. The following is a listing of the activities for this inspection: Reviewed one current resident record and one discharged resident record. Reviewed medication administration records. Three staff records were reviewed. No discrepancies were found with the CRF matrix. One staff member and one resident were interviewed. An inspection of the interior and exterior of the facility was completed. Other documentation reviewed during this inspection included, but was not limited to the following: emergency drill documentation, menus, and staff work schedules. The Program Director and the Team Leader were interviewed during the preliminary findings meeting held at the facility on 10/12/22. The exit meeting was held on 10/19/22 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 Michele Freeman, Licensing Inspector at (804) 662-7062 or by email at michele.freeman@dss.virginia.gov.

Violations:

Standard #:	22VAC40-151-240-B-10
Description:	Violation: Based on review of the personnel record and interview with staff, the facility failed to maintain an up to date personnel record for staff, S1. Findings: 1) Staff, S1, holds the position of Residential Relief Counselor. 2) The personnel record for S1 does not contain a current job description for Residential Relief Counselor. 3) During the interview, staff, S3,, acknowledged job description was missing from the personnel record.
Plan of Correction:	Job description was signed and placed in employees file. On 10/ 22/2022. Director will ensure a copy of the job descriptions that is reviewed with staff during new hire orientation is signed by the staff member and filed in personnel record.
Standard #:	22VAC40-151-540-C
Description:	Violation: Based on observation, the facility failed to keep the building free from roaches. Findings: 1) Staff, S4, was present during the inspection of the interior of the facility on 10/12/22. 2) While in the facility?s kitchen, two dead roaches were noticed on the floor in the pantry, which contained a variety of food products. 3) During the preliminary findings meeting, S4 was interviewed about the kitchen pantry. S4 confirmed and shared with S3 that there were two dead roaches on the floor of the pantry. 4) S3 acknowledged the inspection findings.
Plan of Correction:	Pantry was disinfected and treated as was the remainder of the house on 10/20/2022. Daily monitoring will be conducted by staff, sighting of any insects shall be immediately reported so that additional treatment and intervention can be arranged.
Standard #:	22VAC40-151-740-E-1-b
Description:	Violation: Based upon review of the current resident?s, CR1?s, record and interview with staff, the physical examination did not include the vision exam. Findings: 1) The ?vision exam? element is blank on CR1?s physical examination document. 2) During the interview, staff, S3, reviewed CR1?s physical examination document and acknowledged the findings.
Plan of Correction:	Staff will be retrained by Oct 30, 2022, to ensure that any staff member staff accompanying residents to intake physical ensures that vision and hearing testing is completed and appropriately documented on the intake physical form. As well as all other components of the physical form. Team leader will be asked to provide quality assurance regarding this documentation.
Standard #:	22VAC40-151-740-E-1-c
Description:	Violation: Based upon review of the current resident?s, CR1?s, record and interview with staff, the physical examination did not include the hearing exam. Findings: 1) The ?hearing exam? element is blank on CR1?s physical examination document. 2) During the interview, staff, S3, reviewed CR1?s physical examination document and acknowledged the findings.
Plan of Correction:	Staff will be retrained by Oct 30, 2022, to ensure that any staff member staff accompanying residents to intake physical ensures that vision and hearing testing is completed and appropriately documented on the intake physical form. As well as all other components of the physical form. Team leader will be asked to provide quality assurance regarding this documentation.