VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Presbyterian Children's Home of Highland
425 Grayson Road
Wytheville, VA 24382
(276) 228-2861

Current Inspector: Jamie Morgan (276) 525-5656

Inspection Date: March 15, 2024

Complaint Related: No

Areas Reviewed:

22VAC40-151 ADMINISTRATION 22VAC40-151 RESIDENTIAL ENVIRONMENT 22VAC40-151 PROGRAMS AND SERVICES 22VAC40-151 DISASTER OR EMERGENCY PLANNING

Technical Assistance:

22VAC40-151-960.C Discussion regarding serious incident reports.

Comments:

Type of inspection: Monitoring An unannounced, mandated inspection was held on 3/15/24 from 11:15 a.m. to 2:45 p.m. A preliminary findings review was held on the same date. The Acknowledgement of Inspection form was provided and left at the facility. An exit interview will be conducted. Number of residents in care at the beginning of the inspection: 11 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: 4 Number of staff records reviewed: 2 Number of interviews conducted with residents: 1 Number of interviews conducted with staff: 2 Additional Comments/Discussion: 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 Dawn Espelage, Licensing Inspector at 540-759-8852 or by email at dawn.espelage@dss.virginia.gov

Violations:

Standard #:	22VAC40-151-800-A
Description:	Violation: Based on record review, the agency failed to develop and implement a written behavior support plan for Resident 4 (R4). Findings: 1. R4?s record did not contain a written behavior support plan. 2. S2 stated the plan had been developed. 3. S2 was provided an opportunity to locate the plan. 4. S2 acknowledged they were unable to locate the behavioral support plan during the inspectors? visit. 5. S2 was provided additional time (another business day) to locate the requested documentation; however, the licensing inspectors did not receive additional documentation. 6. The finding was discussed at the preliminary findings review.
Plan of Correction:	A- Within 30 days of admission, the provider shall develop and implement a written behavior support that allows the resident to self-manage his own behaviors. Each individualized plan shall include: 1. Identification of positive and problem behavior; 2. Identification of triggers for behaviors; 3. Identification of successful intervention strategies for problem behavior; 4. Techniques for managing anger and anxiety; and 5. Identification of interventions that may escalate inappropriate behaviors.