NY DOH Assisted Living Facility — Inspection Report

Champlain Valley Senior Community

📍 10 Gilliland Lane, Willsboro, NY 12996

Inspection Summary

Oct 2021 – Sep 2025
45%
of inspections passed with no issues found
5 of 11 inspections · Oct 2021 – Sep 2025
Inspections with issues
6 of 11 inspections
Total violations cited
42 violations total

Inspection Details

Oct 2021 – Sep 2025
ℹ Violations under dispute through the Inspection Review Process (IRP) are not displayed.
June 12, 2025 Complaint Survey 0 Violations
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✓ No violations found

January 30, 2025 Relicensure, Complaint Survey 31 Violations
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Responsibilities of providers; required notif
Regulation cited: CFR 402.9(b)(1)
Plan/Notice of Correction Approved
Responsibilities of providers; required notif
Regulation cited: CFR 402.9(c)
Plan/Notice of Correction Approved
General provisions
Regulation cited: CFR 487.3 (b)
Plan/Notice of Correction Approved
Resident protections
Regulation cited: CFR 487.5 (a) (3) (x)
Plan/Notice of Correction Approved
Resident protections
Regulation cited: CFR 487.5 (a) (3) (xi)
Plan/Notice of Correction Approved
Resident protections
Regulation cited: CFR 487.5 (b) (1)
Plan/Notice of Correction Approved
Resident funds and valuables
Regulation cited: CFR 487.6 (e)
Plan/Notice of Correction Approved
Resident services
Regulation cited: CFR 487.7 (d) (11)
Plan/Notice of Correction Approved
Resident services
Regulation cited: CFR 487.7 (f) (8)
Plan/Notice of Correction Approved
Resident services
Regulation cited: CFR 487.7 (f) (11) (iii)
Plan/Notice of Correction Approved
Resident services
Regulation cited: CFR 487.7 (f) (11) (x)
Plan/Notice of Correction Approved
Resident services
Regulation cited: CFR 487.7 (f) (12) (ii)
Plan/Notice of Correction Approved
Resident services
Regulation cited: CFR 487.7 (f) (12) (iii)
Plan/Notice of Correction Approved
Resident services
Regulation cited: CFR 487.7 (g) (3)
Plan/Notice of Correction Approved
Food service
Regulation cited: CFR 487.8 (d) (4,8,10-11)
Plan/Notice of Correction Approved
Food service
Regulation cited: CFR 487.8 (e) (9-10)
Plan/Notice of Correction Approved
Personnel
Regulation cited: CFR 487.9 (a) (16)
Plan/Notice of Correction Approved
Records and reports
Regulation cited: CFR 487.10 (g)
Plan/Notice of Correction Approved
Environmental standards
Regulation cited: CFR 487.11 (a)
Plan/Notice of Correction Approved
Environmental standards
Regulation cited: CFR 487.11 (f) (14-15)
Plan/Notice of Correction Approved
Environmental standards
Regulation cited: CFR 487.11 (i) ((4) (i),(
Plan/Notice of Correction Approved
Environmental standards
Regulation cited: CFR 487.11 (i) (4) (ii)
Plan/Notice of Correction Approved
Environmental standards
Regulation cited: CFR 487.11 (k) (11)
Plan/Notice of Correction Approved
Environmental standards
Regulation cited: CFR 487.11 (k) (16)
Plan/Notice of Correction Approved
Disaster and emergency planning
Regulation cited: CFR 487.12 (a-b)
Plan/Notice of Correction Approved
Disaster and emergency planning
Regulation cited: CFR 487.12 (f)
Plan/Notice of Correction Approved
Admission and retention standards.
Regulation cited: CFR 1001.7 (k) (4)
Plan/Notice of Correction Approved
Resident services.
Regulation cited: CFR 1001.10 (i) (1)
Plan/Notice of Correction Approved
Medication management.
Regulation cited: CFR 1001.10 (l)(1)
Plan/Notice of Correction Approved
Supervision in special needs assisted living.
Regulation cited: CFR 1001.10 (n) (5) (i-iii)
Plan/Notice of Correction Approved
Records and reports.
Regulation cited: CFR 1001.12 (b) (1-7)
Plan/Notice of Correction Approved
October 15, 2024 Complaint Survey 1 Violation
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Admission and retention standards.
Regulation cited: CFR 1001.7 (k) (5)
Plan/Notice of Correction Approved
April 15, 2024 Complaint Survey 1 Violation
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Resident protections
Regulation cited: CFR 487.5 (a) (3) (xi)
Plan/Notice of Correction Approved
March 18, 2024 Complaint Survey 0 Violations
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✓ No violations found

November 30, 2023 Relicensure Survey 1 Violation
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Admission standards
Regulation cited: CFR 487.4 (k)
Plan/Notice of Correction Approved
April 11, 2023 Complaint Survey 0 Violations
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✓ No violations found

March 31, 2022 Relicensure, Follow-up Survey 0 Violations
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✓ No violations found

February 7, 2022 Complaint Survey 0 Violations
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✓ No violations found

February 1, 2022 Other Survey 1 Violation
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Records and reports
Regulation cited: CFR 487.10 (e) (2)
Plan/Notice of Correction Approved
October 20, 2021 Relicensure Survey 7 Violations
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General requirements
Regulation cited: CFR 402.4(b)(2)(i)
Plan/Notice of Correction Approved
Notifications of criminal charges or convicti
Regulation cited: CFR 402.8
Plan/Notice of Correction Approved
Responsibilities of providers; required notif
Regulation cited: CFR 402.9(b)(1)
Plan/Notice of Correction Approved
Responsibilities of providers; required notif
Regulation cited: CFR 402.9(c)
Plan/Notice of Correction Approved
Resident services
Regulation cited: CFR 487.7 (a)
Plan/Notice of Correction Approved
Environmental standards
Regulation cited: CFR 487.11 (a)
Plan/Notice of Correction Approved
Environmental standards
Regulation cited: CFR 487.11 (h) (5)
Plan/Notice of Correction Approved

Enforcement & Orders

Oct 2021 – Sep 2025
No enforcement actions during the reporting period.