White Birch Communities

Type of inspection: Renewal Date of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: August 7, 2025, from 9:30 a.m. to 1:35 p.m. The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. Number of residents present at the facility at the beginning of the inspection: 48 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 5 Number of staff records reviewed: 5 Number of interviews conducted with residents: 2 Number of interviews conducted with staff: 3 Observations by licensing inspector: The Licensing Inspector observed the residents during activities and meals. The Licensing Inspector reviewed the following at the time of inspection: fire drills, emergency drills, resident council reports, pharmacy review, healthcare oversight, menus, activity calendars and dietician report. Additional Comments/Discussion: None An exit meeting will be conducted 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 Jessica Gale, Licensing Inspector at (540) 571-0358 or by email at Jessica.Gale@dss.virginia.gov

Type of inspection: Monitoring Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 12/27/2024 9:41am-1:30pm The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. Number of residents present at the facility at the beginning of the inspection: 47 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 4 Number of staff records reviewed: 3 Number of interviews conducted with residents: 4 Number of interviews conducted with staff: 4 Observations by licensing inspector: Medication administration, medication carts, activities, meals, staffing, special diets, staff/resident interactions, required postings, Health care and dietary oversight. Additional Comments/Discussion: None An exit meeting will be conducted 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 Jessica Gale, Licensing Inspector at 540-571-0358 or by email at Jessica.gale@dss.virginia.gov

1. Consider "food source" as opposed to just applesauce for crushed meds in case someone isn't a fan of applesauce. 2. Continue to monitor for physician's order for "apply to affected area".

Type of inspection: Renewal Date of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 8/23/2023 The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. Number of residents present at the facility at the beginning of the inspection: 50 (47 in house) The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Upon arrival the administrator provided a tour of the entire facility and grounds. The facility was clean and odor free. The outside grounds were clear. The memory care unit was determined to be secure including the outside area. Postings were identified throughout the building as required. Number of resident records reviewed: 7 Number of staff records reviewed: 6 Number of interviews conducted with residents: 5 Number of interviews conducted with staff: 3 Observations by licensing inspector: Lunch meal observed which included piano background music by a volunteer. Meals served as per menu and dietary requirements. Medication pass observed which met Board of Nursing requirements. Medication cart clean and organized and schedule drug count was accurate. MARs reviewed contained all the required information and were accurate and timely as it relates to administration. Resident and staff files complete with staff files organized according to the protocol making finding information must easier. All staff training was in order and in many cases exceeded the annual requirement. Facility has multiple nurses on staff as well as a contract physician. Additional Comments/Discussion: Fire Inspection – 6/11/23 Fire, disaster and resident emergency drills all current as per standards. Health Inspection – 8/15/23 Outside reviews and oversight – all current Thank you to staff and residents for your cooperation during this renewal inspection process. An exit meeting will be conducted to review the inspection findings. The evidence gathered during the inspection determined no violations with applicable standard(s) or law. The inspection summary will be posted to the VDSS website within five (5) business days of your receipt of the inspection summary. 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. Should you have any questions, please contact Sharae Henderson, Licensing Administrator at 804-726-7833 or by email at sharae.henderson@dss.virginia.gov

1. Ensure all treatments that are ordered are well documented, including refusals. Include all treatments on the medication/treatment administration record to ensure complete documentation. 2. Audit documentation on a regular basis to ensure compliance. 3. Consult with physician regarding self-administration or discontinuation if the treatments continue to be refused and document all information in the resident’s record.

Type of inspection: Complaint Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 9/16/2022 from approximately 1:00 pm to 4:15 pm The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. A complaint was received by VDSS Division of Licensing on 8/31/2022 regarding allegations in the areas of: Staffing, resident care and related services, resident accommodations and buildings and grounds. Number of residents present at the facility at the beginning of the inspection: 44 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 1 Number of staff records reviewed: 0 Number of interviews conducted with residents: 1 Number of interviews conducted with staff: 3 Additional Comments/Discussion: None. An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation supported some, but not all of the allegations; area(s) of non-compliance with standard(s) or law were: Resident care and related services. A violation notice was issued; any violation(s) not related to the complaint but identified during the course of the investigation can also be found on the violation notice. 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 Janice Knight, Licensing Inspector at (540) 430-9258 or by email at janice.knight@dss.virginia.gov

Answered questions and discussed the following: 1. When a staff is rehired, they are considered a new employee and must complete all required paperwork within the required timeframes upon hire; however, serious cognitive impairment (SCI) training completed the year prior to the new hire date may be counted toward the required SCI training. 2. Even though the administrator trains staff on the infection control policy annually, ensure the infection control policy is signed/dated as reviewed for updates and changes annually as well (the same with the emergency preparedness plan). 3. Answered questions about fire drill participation and using the fire alarm at night – recommended the administrator contact the fire official regarding required fire drill procedures. 4. Recommended adding a statement to the individualized service plan for signature of resident/family member that a copy was received. 5. Administrator responses regarding any recommendations made by the council or resolution of problems or concerns must be issued prior to the next council meeting and kept on file. 6. Answered questions about health care oversight and explained all residents must be reviewed each year – not each quarter.

Type of inspection: Monitoring Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 9/14/2022 from approximately 7:40 am to 5:00 pm, 9/15/2022 from approximately 8:10 am to 3:45 pm and 9/16/2022 from approximately 10:00 am to 1:00 pm. The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. Number of residents present at the facility at the beginning of the inspection: 44 (28 assisted living, 16 secured unit) The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 8 Number of staff records reviewed: 4 + selected sections of 4 additional staff + 1 contract staff Number of interviews conducted with residents: 5 Number of interviews conducted with staff: 6 Observations by licensing inspector: Medication administration, postings, emergency food and water supplies, activities, meals and special diets. Additional Comments/Discussion: None An exit meeting will be conducted 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 Janice Knight, Licensing Inspector at (540) 430-9258 or by email at janice.knight@dss.virginia.gov

Ensure all residents/legal representatives sign that they received a copy of the resident agreement.

The licensing inspector conducted an unannounced complaint inspection in response to a complaint that was received by the licensing office on 4/18/2022. Interviews were conducted with staff, family members and outside agency staff relating to allegations of neglect, insufficient staffing, poor cleanliness and copies of resident agreement not being provided to residents/legal representatives. The information gathered during the investigation did not support the allegations of neglect, insufficient staffing or poor cleanliness. The information gathered; however, did support the allegation that one legal representative did not receive a copy of the resident agreement. Please complete the columns for “description of action to be taken” and “date to be corrected” for the violation cited on the violation notice, and then return a signed and dated copy to the licensing office within five calendar days of receipt. If you have any questions, contact your licensing inspector at (540) 430-9258.

Recommendations given to the administrator: 1. Ensure all registered medication aides and nurses receive regular in-services on medication and treatment refusals, medication administration and treatment documentation, and reporting protocols. 2. A new health and fire inspection must be received by the licensing office before a new license may be issued.

A renewal inspection was initiated on 7/30/2021 and concluded on 8/4/2021. The administrator was contacted by telephone to initiate the inspection. The administrator reported that the current census was 43. The inspector emailed the administrator a list of items required to complete the remote documentation review portion of the inspection. The inspector reviewed three resident and four staff records, selected sections of five resident, one contract staff and three staff records, activities calendar, menu, staff schedules, fire drills, health care oversight, dietary reviews, medication administration records, physicians' orders and other information submitted by the facility to ensure documentation was complete. The inspector conducted the on-site portion of the inspection on 8/4/2021. An exit interview was conducted with the administrator on the date of the inspection, where findings were reviewed and an opportunity was given for questions, as well as for providing any information or documentation which was not available during the inspection. Information gathered during the inspection determined non-compliance with applicable standards or law, and violations were documented on the violation notice issued to the facility.