WINDSORMEADE WILLIAMSBURG, PINNACLE LIVING — Virginia Inspection Report

Inspections

On record

With violations

Visits that cited something

Clean visits

Nothing cited

Violations cited

Individual findings

Standards cited

Distinct rules

Complaint visits

Prompted by a complaint

WINDSORMEADE WILLIAMSBURG, PINNACLE LIVING was inspected 8 times between April 7, 2021 and March 25, 2026 by the Virginia Department of Social Services. 2 of those visits ended with violations cited and 6 with none. Across that history VDSS cited 7 violations under 7 distinct standards. 2 inspections were prompted by a complaint.

A violation is a licensing standard - a rule in the Virginia Administrative Code - that the inspector found the facility was not meeting. Each is shown with the evidence the inspector recorded and, where VDSS publishes it, the facility's own plan of correction.

VDSS publishes inspections on a rolling window. 7 of these 8 are still on the state's site; the other 1 has since dropped off it and is reproduced from Assisted Living Magazine's archive of the original VDSS reports.

Provider Information

Facility type

Assisted Living Facility

License type

Two Year

License expires

03/31/2028

Administrator

Amanda Austin

Licensing inspector

Alyshia Walker

Inspector phone

(757) 670-0504

Approved for

Assisted Living · Non-Ambulatory · Special Care Unit

Inspection History

Select an inspection to read the areas reviewed, the inspector's comments and any violations cited.

March 25, 2026Inspection0 violations

Inspection dates

03/25/2026

Areas reviewed

22VAC40-73 GENERAL PROVISIONS22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES22VAC40-73 PERSONNEL22VAC40-73 STAFFING AND SUPERVISION22VAC40-73 ADMISSION, RETENTION AND DISCHARGE OF RESIDENTS22VAC40-73 RESIDENT CARE AND RELATED SERVICES22VAC40-73 RESIDENT ACCOMMODATIONS AND RELATED PROVISIONS22VAC40-73 BUILDINGS AND GROUND22VAC40-73 EMERGENCY PREPAREDNESS22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTSARTICLE 1 – SUBJECTIVITY22VAC40-90 BACKGROUND CHECKS FOR ASSISTED LIVING FACILITIES22VAC40-90 THE SWORN STATEMENT OR AFFIRMATION22VAC40-90 THE CRIMINAL HISTORY RECORD REPORT22VAC40-80 THE LICENSE

Technical assistance

22VAC40-73-(9) EMERGENCY PREPAREDNESS ARTICLE 1 – SUBJECTIVITY

Comments

Type of inspection: Renewal Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 3/25/206 10:00 am- 4:00 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: 30 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: 2 Number of interviews conducted with staff: 3 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. For more information about the VDSS Licensing Programs, please visit: www.dss.virginia.gov Should you have any questions, please contact Alyshia Walker, Licensing Inspector at 757-670-0504 or by email at Alyshia.Walker@dss.virginia.gov

Violations

✅

No violations cited

The inspector documented no violation of standards at this inspection.

August 12, 2025Complaint survey0 violations

Inspection dates

08/12/2025

Areas reviewed

22VAC40-73 RESIDENT CARE AND RELATED SERVICES22VAC40-80 COMPLAINT INVESTIGATION

Comments

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: 8/12/2020 11:30 am- 1:09 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 5/29/2025 regarding allegations in the area(s) of: Resident Care and Related Services Number of residents present at the facility at the beginning of the inspection: 27 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 2 Number of staff records reviewed: 0 Number of interviews conducted with residents: 0 Number of interviews conducted with staff: 2 Observations by licensing inspector: The inspector review resident charts which included observation notes, fall risk assessments, UAIs and ISPs. Additional Comments/Discussion: n/a An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation did not support the (allegation(s)/self-report) of non-compliance with standard(s) or law. The inspection summary will be posted to the VDSS website within 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. For more information about the VDSS Licensing Programs, please visit: www.dss.virginia.gov Should you have any questions, please contact Alyshia Walker, Licensing Inspector at 757-670-0504 or by email at Alyshia.Walker@dss.virginia.gov

Violations

✅

No violations cited

The inspector documented no violation of standards at this inspection.

February 3, 2025Inspection6 violations

Inspection dates

Feb. 3, 2025

Areas reviewed

22VAC40-73 GENERAL PROVISIONS22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES22VAC40-73 PERSONNEL22VAC40-73 STAFFING AND SUPERVISION22VAC40-73 ADMISSION, RETENTION AND DISCHARGE OF RESIDENTS22VAC40-73 RESIDENT CARE AND RELATED SERVICES22VAC40-73 RESIDENT ACCOMMODATIONS AND RELATED PROVISIONS22VAC40-73 BUILDINGS AND GROUND22VAC40-73 EMERGENCY PREPAREDNESS22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS22VAC40-90 BACKGROUND CHECKS FOR ASSISTED LIVING FACILITIES22VAC40-90 THE SWORN STATEMENT OR AFFIRMATION22VAC40-90 THE CRIMINAL HISTORY RECORD REPORT22VAC40-80 THE LICENSE

Comments

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: 2/3/2025 8:00 am- 1:30 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: 31 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: 3 Number of interviews conducted with staff: 5 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 Alyshia Walker, Licensing Inspector at 757-670-0504 or by email at Alyshia.Walker@dss.virginia.gov

Violations

22VAC40-73-650-A

Based on record review and discussion, the facility failed to ensure no medication, dietary supplement, diet, medical procedure, or treatment be started, changed, or discontinued by the facility without a valid order from a physician or other prescriber. Medications include prescription, over-the-counter, and sample medications.

Evidence

A review of the MAR for Resident # 2 contained Tylenol Extra Strength Oral Tablet 500 mg to be given 2 tablets by mouth two times a day for pain which was to start 12/31/2024. There was no signed order in the resident’s chart. The facility was unable to locate a signed physician’s order for the medication on the day of the inspection.
Staff #2 and #3 acknowledged the resident’s file did not contain a signed order.

Plan of correction

1. Facility identified that resident orders had not been electronically signed by the physician in the medical record. 2. Facility has reviewed the current policy for Prescribers Medication Orders. The policy meets the standard for all orders to be reviewed and signatures to be completed within 14 days. The providers have been re-educated. 3. Orders for Resident # 2 have been signed. 4. Director of Health Services will audit physician orders weekly to ensure that any new orders have been electronically signed by the MD and NP. 5. Audit reports will be reported through the facility QAPI process quarterly with corrective actions as necessary.

22VAC40-73-450-E

Based on records reviewed and staff interviewed, the facility failed to ensure the individualized service plan (ISP) shall be signed and dated by the resident or the legal representative.

Evidence

The ISP for Resident # 2 (with a staff signature date of 10/28/24) did not contain a resident or POA signature.
The ISP for Resident # 4 (with a staff signature date of 10/24/2024) did not contain a resident or POA signature.
Staff # 3 acknowledged the ISPs did not contain resident or POA signatures.

Plan of correction

1. Facility has identified that the residents/POA did not sign the ISP’s per the standard. All residents could be affected. Facility will review medical records for all residents to verify signed ISP’s are entered. 2. The facility has reviewed the current policy and the policy meets the standards for obtaining signatures of residents/POA’s on the ISP. 3. The resident will be asked to sign the ISP (Resident # 2) and the RR/POA will be asked to sign for Resident # 4. These will then be scanned into the medical record. 4. A monthly audit will be completed to review any newly completed ISP’s or revised ISP’s have been signed and entered in the medical record. 5. Audit reports will be reported through the facility QAPI process quarterly with corrective actions as necessary.

22VAC40-73-260-A

Based on a review of staff records, the facility failed to ensure each direct care staff member who does not have current certification in first aid as specified in subdivision 1 of this subsection shall receive certification in first aid within 60 days of employment.

Evidence

At the time of inspection, the employee file for Staff #7 (D.O.H. 12/4/2024 did not contain verification of First Aid.
Staff # 4 acknowledged the file did not contain verification of First Aid.

Plan of correction

1. Facility confirmed that Staff # 7 did not have current First Aid training, only CPR training. 2. Facility has reviewed its current policy which meets the standard. Facility always has an LPN on duty. Standard is unclear, it states that at least one person at all times who has current first aid certification or is a licensed practical nurse has to be in each building, which was met. 3. Staff # 7 was no longer employed with WindsorMeade, therefore First Aid Training was not completed. Any other team members identified as not having First aid certification will be scheduled for a class. 4. HR will audit all new hire records within 7 days of start of employment to ensure that this is completed. 5. Audit reports will be reported through the facility QAPI process quarterly with corrective actions as necessary.

22VAC40-73-250-D

Based on a review of staff records the facility failed to ensure that each staff person submit the results of a tuberculosis (TB) risk assessment on or within seven days prior to the first day of work at the facility and that each staff person submit the results of a risk assessment annually.

Evidence

The file for Staff #7 (D.O.H. 12/4/2024) contained a TB risk assessment with a completion date of 10/23/2024.
Staff # 4 acknowledged the TB risk assessment was older than 30 days prior to the staff member’s first day of work.

Plan of correction

1. Facility identified that team members TB risk assessment was within 30 days of her hire date, but not within 30 days of her first day of work. 2. Facility has reviewed its current policy which meets the standard. 3. Staff # 7 was no longer employed with WindsorMeade, therefore risk assessment could not be completed. Any other records identified as out of compliance will be corrected. 4. HR will audit all new hire records within 7 days of start of employment to ensure that this is completed. 5. Audit reports will be reported through the facility QAPI process quarterly with corrective actions as necessary.

22VAC40-73-440-B

Based on record review, the facility failed to ensure the uniform assessment instrument (UAI) was completed by one of the following qualified assessors: An assisted living facility staff person who has successfully completed state- approved training on the uniform assessment instrument and level of care criteria for either public or private pay assessments, provided the administrator or the administrator's designated representative has successfully completed such training and approves and then signs the completed UAI.

Evidence

The UAI for Resident #4 dated 10/14/2024 did not contain an administrator or administrator’s representative signature.
Staff # 2 acknowledged the UAI did not contain an administrator or administrator’s representative signature.

Plan of correction

1. Facility has confirmed that the administrator’s designated representative, the Director of Health Services, has completed the approved training for signing the completed UAI’s. 2. Facility has reviewed the current process for obtaining signatures from the designated representative. The assessment for Resident # 4 has been signed. 3. Team members will now be notifying the Director of Health Services immediately in writing via email once an assessment is ready to be reviewed and signed in the electronic medical record. 4. Facility will audit the UAI’s monthly to ensure that all signatures are completed. 5. Audit reports will be reported through the facility QAPI process quarterly with corrective actions as necessary.

22VAC40-73-250-C

Based on a review of staff records, the facility failed to verify that each staff person has received a copy of his or her current job description.

Evidence

The Staff file for Staff #7 did not contain a signed job description at the time of the inspection.
Staff #4 acknowledged the file did not contain a job description.

Plan of correction

1. Facility identified the Staff # 7 was missing a signed job description. 2. Facility has reviewed its current HR policy and the policy meets the standard. HR has completed a 100% audit on job descriptions to ensure compliance. 3. Staff # 7 was no longer employed with WindsorMeade, therefore job description could not be completed. All other records that were identified as out of compliance will be corrected. 4. HR will audit all new hire records within 7 days of start of employment to ensure that this is completed. 5. Audit reports will be reported through the facility QAPI process quarterly with corrective actions as necessary.

February 3, 2025Complaint survey0 violations

Inspection dates

02/03/2025

Areas reviewed

22VAC40-73 RESIDENT CARE AND RELATED SERVICES22VAC40-80 COMPLAINT INVESTIGATION

Comments

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: 2/3/2025 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 10/3/2024 regarding allegations in the area(s) of: Resident Care and Related Services Number of residents present at the facility at the beginning of the inspection: 31 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of staff records reviewed: 0 Number of interviews conducted with residents: 2 Number of interviews conducted with staff: 4 Observations by licensing inspector: License Inspector observed a meal. An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation did not support the allegation(s) of non-compliance with standard(s) or law. The inspection summary will be posted to the VDSS website within 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. For more information about the VDSS Licensing Programs, please visit: www.dss.virginia.gov Should you have any questions, please contact Alyshia Walker, Licensing Inspector at 757-670-0504 or by email at Alyshia.Walker@dss.virginia.gov

Violations

✅

No violations cited

The inspector documented no violation of standards at this inspection.

May 7, 2024Inspection0 violations

Inspection dates

05/07/2024

Areas reviewed

22VAC40-73 GENERAL PROVISIONS22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES22VAC40-73 PERSONNEL22VAC40-73 STAFFING AND SUPERVISION22VAC40-73 ADMISSION, RETENTION AND DISCHARGE OF RESIDENTS22VAC40-73 RESIDENT CARE AND RELATED SERVICES22VAC40-73 RESIDENT ACCOMMODATIONS AND RELATED PROVISIONS22VAC40-73 BUILDINGS AND GROUND22VAC40-73 EMERGENCY PREPAREDNESS22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS22VAC40-90 THE SWORN STATEMENT OR AFFIRMATION22VAC40-90 THE CRIMINAL HISTORY RECORD REPORT22VAC40-80 THE LICENSE

Technical assistance

Resident Care and Related Services

Comments

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: 5/7/2024 10:00 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 present at the facility at the beginning of the inspection: 27 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 10 Number of staff records reviewed: 3 Number of interviews conducted with residents: 3 Number of interviews conducted with staff: 3 Observations by licensing inspector: Licensing Inspector observed activities, a meal, call bell responses, reviewed emergency food and water supply, and medication passes. 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. For more information about the VDSS Licensing Programs, please visit: www.dss.virginia.gov Should you have any questions, please contact Alyshia Walker, Licensing Inspector at 757-670- 0504 or by email at Alyshia.Walker@dss.virginia.gov

Violations

✅

No violations cited

The inspector documented no violation of standards at this inspection.

March 27, 2023Inspection1 violation

Inspection dates

03/27/2023, 03/28/2023

Areas reviewed

22VAC40-73 GENERAL PROVISIONS22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES22VAC40-73 PERSONNEL22VAC40-73 STAFFING AND SUPERVISION22VAC40-73 ADMISSION, RETENTION AND DISCHARGE OF RESIDENTS22VAC40-73 RESIDENT CARE AND RELATED SERVICES22VAC40-73 RESIDENT ACCOMMODATIONS AND RELATED PROVISIONS22VAC40-73 BUILDINGS AND GROUND22VAC40-73 EMERGENCY PREPAREDNESS22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS22VAC40-90 BACKGROUND CHECKS FOR ASSISTED LIVING FACILITIES22VAC40-90 THE SWORN STATEMENT OR AFFIRMATION22VAC40-90 THE CRIMINAL HISTORY RECORD REPORT22VAC40-80 THE LICENSE

Comments

Type of inspection: Renewal Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 3/27/2023 10:00 am – 5:35 pm and 3/28/2023 9:15am-1:52pm 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: 28 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 7 Number of staff records reviewed: 3 Number of interviews conducted with residents:3 Number of interviews conducted with staff: 3 Observations by licensing inspector: Some of the areas Licensing Inspector observed were scheduled activities, medication observations, First- Aid kits, emergency food and water supply and resident rooms. Additional Comments/Discussion: 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 Alyshia Walker, Licensing Inspector at (757)670-0504 or by email at Alyshia.Walker@dss.virginia.gov

Violations

22VAC40-73-325-B

Based on records reviewed and staff interviewed, the facility failed to ensure that a fall risk assessment was reviewed and updated after every fall.

Evidence

Resident # 1 had a documented fall on 11/16/2022 and there was no fall assessment completed.
Resident # 2 had a documented falls on 12/7/2022, 1/21/2023, 2/9/2023 and 2/12/2023 and no fall assessments were completed.
Resident # 3 had documented falls on 10/26/2022, 10/30/22, 11/16/2022, 12/25/2022,12/30/2022, 1/1/2023, 2/24/2023,3/3/2023, and 3/4/2023 and no fall assessments were completed.
Resident # 5 had a documented fall on 3/1/2023 and there was no fall assessment completed.
Staff #2 and #3 acknowledged that falls risk assessments were not completed on the aforementioned falls.

Plan of correction

1. Facility self-identified through quality control audits on 3/10/23 an opportunity to improve fall risk assessments and initiated a plan of correction immediately as outlined below. 2. Facility will review the current Falls policy for accuracy and to ensure it meets the regulation 22VAC40-73-325B. 3. Facility nurses will be re-educated on facility Falls policy and on completion of Fall Risk assessments post fall. Team members will be re-trained and/or subject to disciplinary action for non-compliance with the standard ongoing. 4. Facility will audit the falls process, to include completion of fall risk assessments, monthly for the next 6 months. Any concerns will be immediately corrected. Audits will be completed by Administrator, Director of Nursing, Clinical Leader and/or designee. Audits will be reported through the facility QAPI process quarterly with corrective actions as necessary.

March 17, 2022Inspection0 violations

Inspection dates

03/17/2022

Areas reviewed

22VAC40-73 PERSONNEL22VAC40-73 STAFFING AND SUPERVISION22VAC40-73 ADMISSION, RETENTION, AND DISCHARGE OF RESIDENTS22VAC40-73 RESIDENT CARE AND RELATED SERVICES22VAC40-73 RESIDENT ACCOMODATIONS AND RELATED PROVISIONS

Comments

A Inspector with the Division of Licensing conducted an unannounced, mandated, monitoring inspection on 03/17/2022 from 9:30 am to 2:30pm. During the inspection the Licensing Inspector reviewed 5 resident records and 3 staff records, observed the facility physical plant during meal times, observed the facility emergency water and food supply, observed the facility first aid kit and reviewed additional facility documentation for compliance. During the inspection the facility had no violations. Please contact the facility Licensing Inspector, Kimberly Rodriguez at 757-586-4004 or by email at Kimberly.rodriguez@dss.virginia.gov for additional questions and or concerns.

Violations

✅

No violations cited

The inspector documented no violation of standards at this inspection.

April 7, 2021Inspection0 violations

Inspection dates

April 7, 2021 and April 12, 2021

Areas reviewed

Comments

This inspection was conducted by 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 04/07/2021 and concluded on 04/12/2021. The Administrator was contacted by telephone to initiate the inspection. The Administrator reported that the current census was 22. The inspector emailed the Administrator a list of items required to complete the inspection. The inspector reviewed 3 resident records, 3staff records, and additional documents submitted by the facility to ensure documentation was complete. The information gathered during the inspection determined no violations with applicable standards or law. No violations were issued.

Violations

✅

No violations cited

The inspector documented no violation of standards at this inspection.