Crestwood Assisted Living

Type of inspection: Monitoring Date of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 9/3/2025 10:00 a.m. – 2:50 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: 88 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 6 Number of staff records reviewed: 3 Number of interviews conducted with residents: 2 Number of interviews conducted with staff: 2 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: Renewal Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 08/21/2024, 10:02am – 4:15pm 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: 82 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 6 Number of staff records reviewed: 3 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, meals and in their apartments. The following were reviewed at the time of inspection: Menus, activity calendars, fire drills, emergency drills, resident council minutes, dietician report, healthcare oversight. Additional Comments/Discussion: None 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 Jessica Gale, Licensing Inspector at 540-571-0358 or by email at Jessica.gale@dss.virginia.gov

Type of inspection: Monitoring Inspection Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 04/25/2024 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: 74 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: 4 Number of interviews conducted with residents: 2 Number of interviews conducted with staff: 4 Observations by licensing inspector: Li observed residents participating in activity programs and eating lunch. This LI also observed a medication administration pass. Additional Comments/Discussion: 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 Sarah Pearson, Licensing Inspector at (540) 680-9469 or by email at sarah.pearson@dss.virginia.gov

Topics discussed with the assisted living facility administrator and the management team: 1. Now that the facility is transitioning from paperwork to electronic documents, ensure all documents that require a signature are still signed either electronically or by an actual wet signature (such as sworn statements, residents’ rights, etc.). 2. Obtaining a non-toxic dish liquid so residents may wash their own dishes when using the kitchen area on each unit. 3. When starting to replace windows, ensure the locking devices that prevent windows in the common and bedroom areas from opening enough for a resident to crawl through are reinstalled on the windows in all rooms/units where cognitively impaired residents reside. 4. Providing the medication administration record instead of the medication list when sending out a resident by rescue squad. 5. Reviewed, discussed and answered questions on the healthcare oversight process and explained full reviews are required at least annually on every resident (facility currently does monthly reviews on selected sections of residents’ records). 6. Conducting in-services along with the fire drills. 7. Only required to post all direct care/nursing staff who are certified in first aid/cardiopulmonary resuscitation – are not required to post other staff certifications or their expiration dates.

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: 8/15/2022 from approximately 8:45 am to 5:40 pm, 5/16/2022 from approximately 8:15 am to 5:45 pm and 8/17/2022 from approximately 9:00 am to 4:30 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: 71 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 + selected sections of 3 additional records Number of staff records reviewed: 5 + 2 volunteer records + 6 private sitter records and selected sections of 2 additional staff records Number of interviews conducted with residents: 7 Number of interviews conducted with staff: 7 Observations by licensing inspector: Medication administration observations, medication cart checks, meals/special diets, activities and staff/resident interactions. Additional Comments/Discussion: The facility is transitioning from paper documents to online documents, thus, more time was required to collect the required information to complete the inspection. 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

Recommended auditing medication administration records on a weekly basis and providing an in-service to ensure all staff are documenting as needed (PRN) medications the same way consistently. The required information was documented; however, staff were not consistently documenting in both places indicated on the electronic medication administration records.

A non-mandated monitoring inspection was initiated on 10/12/2021 and concluded on 10/13/2021. The administrator was contacted by telephone to conduct the inspection. The licensing inspector emailed the administrator a list of documentation required to complete the inspection. The evidence gathered during the inspection determined no violations with applicable standards. No violations were issued.

Recommendations discussed with the administrator: 1) Putting the time frames of all activities that are more then 30 minutes in length due to the statement on the activities calendar that all activities are at least 30 minutes. 2) Contacting the fire official to clarify the requirements for conducting a fire drill.

A renewal inspection was initiated on 8/17/2021 and concluded on 08/19/2021. The administrator was contacted by telephone to initiate the inspection. The administrator reported that the current census was 78. The inspector emailed the administrator a list of items required to compete the remote documentation review portion of the inspection. The inspector reviewed four resident and four staff records, selected sections of one resident and five 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 8/19/2021. 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.