Masonic Home of Virginia

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: 2/4/2026 1:00 – 3:00p The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. Number of resident records reviewed: 1 Number of interviews conducted with staff: 2 Observations by licensing inspector: Weekly Skin Checks, Fall Event History, Challenging Moments Documentation 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. Violation Notice Issued: No By signature, the facility representative acknowledges receipt of the inspection findings, including the Inspection Summary, Violation Notice (if applicable), and Supplemental Information, and affirms that the inspector reviewed all information contained therein. For more information about the VDSS Licensing Programs, please visit: www.dss.virginia.gov Should you have any questions, please contact Tamara Watkins, Licensing Inspector at (804) 840-3710 or by email at tamara.g.watkins@dss.virginia.gov Inspector Signature: Date Issued: 3/2/2026 Facility Representative Signature: Date: 3/2/2026

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: 02/04/2026 1:00p – 3:00p 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: 81 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 staff: 3 Additional Comments/Discussion: 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 Tamara Watkins, Licensing Inspector at (804) 840-3710 or by email at tamara.g.watkins@dss.virginia.gov Violation Notice Issued: No

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: 6/12/2025 1:00p – 4:00p 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: 75 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: Residents, activity, menus, dining area, memory support, medication administration, resident emergency practice exercises Additional Comments/Discussion: 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 Tamara Watkins, Licensing Inspector at (804) 840-3710 or by email at tamara.g.watkins@dss.virginia.gov Violation Notice Issued: No

Type of inspection: Renewal Date(s) of inspection 7/11/2023 1:00a – 3:30p. The licensing inspector was on-site at the facility for each day of the inspection. 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: 10 Number of staff records reviewed: 5 Number of interviews conducted with residents: 2 Number of interviews conducted with staff: 1 Additional Comments/Discussion: 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 Tamara Watkins, Licensing Inspector at (804) 662-7422 or by email at tamara.g.watkins@dss.virginia.gov Violation Notice Issued: No

Type of inspection: Monitoring Date(s) of inspection 3/21/2023 11:30a – 3:15p. The licensing inspector was on-site at the facility for each day of the inspection. 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: 10 Number of staff records reviewed: 5 Number of interviews conducted with residents: 2 Number of interviews conducted with staff: 2 Additional Comments/Discussion: 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 Tamara Watkins, Licensing Inspector at (804) 662-7422 or by email at tamara.g.watkins@dss.virginia.gov Violation Notice Issued: No

An unannounced monitoring inspection was conducted on this date from 10:45 p- 3:00 p. At the time of the inspection there were 74 residents in care. Six resident and five staff files were reviewed as well as other required documentation. All new personnel records were reviewed since the last inspection for criminal history record reports and all were in compliance. Fire and Health inspection reports were reviewed, menus, activities were observed, resident's interviewed etc. Building and grounds were inspected. An exit meeting was held with the Administrator. This inspection determined there were no violations with applicable standards or law. No violations were issued.

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 4/30/2021 and concluded on 5/12/2021. The administrator was contacted by telephone to initiate the inspection. The administrator reported that the current census was 81. The inspector emailed the administrator a list of items required to complete the inspection. The inspector reviewed (5) five resident records, (5) five staff records, staff schedules, medication administration records, service plans and other required documentation submitted by the facility to ensure documentation was complete. Information gathered during the inspection determined non-compliance(s) with applicable standards or law, and a violation was documented on the violation notice issued to the facility.