Yama Services #2

Type of inspection: Complaint. Date the licensing inspector was on-site at the facility for each day of the inspection: 11/10/25 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 11/3/25 regarding allegations in the areas of: Administration and Administrative Services, Personnel, Resident Care and Related Services Number of residents present at the facility at the beginning of the inspection: 7 The licensing inspector completed a tour of the physical plant Number of interviews conducted with staff: 1 An exit meeting was conducted to review the inspection findings. The evidence gathered during the investigation did not support the allegations of non-compliance with standards 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 Yvonne Randolph, Licensing Inspector at (804) 441-1180 or by email at yvonne.randolph@dss.virginia.gov

Type of inspection: Renewal Date of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 9/12/25, 10:30 am to 11:45 am 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: 8 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: 2 Number of interviews conducted with residents: 1 Number of interviews conducted with staff: 1 Observations by licensing inspector: Medication storage and administration, physical plant, staff/resident interactions, file documentation, postings An exit meeting was conducted to review the inspection findings. The evidence gathered during the inspection determined non-compliance with applicable standards or law, and a violation was 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 will be addressed in order to return the facility to compliance and maintain future compliance with applicable standards 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 Yvonne Randolph, Licensing Inspector at (804) 441-1180 or by email at yvonne.randolph@dss.virginia.gov

Type of inspection: Complaint Date of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 1/17/24, 10 am to 2:30 pm The Acknowledgement of Inspection form was emailed to the facility for each date of the inspection. A complaint was received by VDSS Division of Licensing on January 8, 2025 regarding allegations in the areas of: Staffing and Supervision, Personnel, Building and Grounds, Resident Care and Related Services, Resident Accommodations and Related Provisions, Administration and Administrative Services. Number of residents present at the facility at the beginning of the inspection: 7 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: 2 Number of interviews conducted with residents: 2 Number of interviews conducted with staff: 2 Observations by licensing inspector: resident rooms, resident hygiene and grooming, file documentation, resident/staff interaction, facility cleanliness, bed linens, required postings, lunch meal, activities, medication storage and staff/resident file documentation Comments: The licensing inspector reviewed hospice agency notes, admission photos, text messages for 3 years An exit meeting was conducted to review the inspection findings. The evidence gathered during the investigation supported some, but not all of the allegations; areas of non-compliance with standards or law were: Resident Accommodations and Related provisions, Resident Care and Related Services and Personnel A violation notice was issued, any violation 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 violations 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 Yvonne Randolph, Licensing Inspector at (804) 662-7454 or by email at yvonne.randolph@dss.virginia.gov

Documentation of DNR

Type of inspection: Mandated Monitoring Date of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 12/6/24, 10:30 a 11:30 a 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: 5 Number of resident records reviewed: 2 Number of staff records reviewed: 2 Number of interviews conducted with residents: 0 Number of interviews conducted with staff: 2 Observations by licensing inspector: file documentation, medication administration An exit meeting was 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 Yvonne Randolph, Licensing Inspector at (804) 662-7454 or by email at yvonne.randolph@dss.virginia.gov

Type of inspection: Renewal Unannounced Mandated. Date of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 9/18/23 11:00 a to 12:30 a and 9/25/23 12;45 to 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: 8 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: 2 Number of interviews conducted with residents: 0 Number of interviews conducted with staff: 2 Observations by licensing inspector: Lunch meal, activity, resident staff interaction, medication storage and administration An exit meeting was 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 (name), Licensing Inspector at 804-662-7454 or y email at yvonne.randolph@dss.virginia.gov

Type of inspection: Renewal Date of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 8/22/22, 2 -3 pm 8/24/22 8-9:30 am Number of residents present at the time of inspection: 7 Number of resident records reviewed: 2 Number of staff records reviewed: 3 Number of interviews conducted with residents: 0 Number of interviews conducted with staff: 2 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Observations by licensing inspector: Medication Storage/administration, Postings, Infection Control Additional Comments/Discussion: A renewal inspection was completed on 8/22/2022 and 8/24/2022 The evidence gathered during the inspection determined no violations with applicable standard or law. 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. An exit meeting was conducted to review the inspection findings. For more information about the VDSS Licensing Programs, please visit: www.dss.virginia.gov Should you have any questions, please contact Yvonne Randolph, Licensing Inspector at (804) 662-7454 or by email at yvonne.randolph@dss.virginia.gov

A 60 day mandated monitoring inspection was initiated on 6/7/2022 and concluded on 6/21/2022. The administrator was on site and reported 7residents in care on the day of the inspection. The inspector inspected the building for compliance, interviewed two residents and reviewed two (2) resident files, one (1) new staff file, medication storage and administration, required postings, infection control protocols. The inspector shared the results of the inspection with the administrator on 6/21/2022, where findings were reviewed and an opportunity was given for questions, as well as for providing any additional information or documentation. The information gathered during the inspection determined one non-compliance with applicable standards or law, the violation is documented on the violation notice issued to the facility. A 60 day mandated monitoring inspection was initiated on 6/7/2022 and completed on 6/21/2022.

An initial inspection was completed on 4/11/2022. The applicant was on-site during the inspection. The inside and outside of the facility along with required postings, furnishings, etc. Policies and procedures were reviewed prior to the inspection. The licensed capacity will be eight residents based on room measurements, the current regulations for square footage of resident bedrooms and the Building Evaluation completed by the local authority. An exit interview was conducted with applicant on the date of inspection, where findings were reviewed. The information gathered during the inspection determined no violations with applicable standards or law. No violations were issued.