The Department of Social Services (DSS) sat down with NBC12 to discuss how an assisted living facility can be found in repeated violations yearly and have seemingly no punishment.
NBC12 reached out to DSS during our investigation into Jones & Jones Assisted Living Facility located at 7804 and 7806 Forest Hill Avenue in Richmond. Current and former residents of the facility complained of neglectful practices by staff, uncleanliness in the rooms, bathrooms and halls, bed bugs, lack of hygiene materials and overall poor conditions at the facility. Through our research, NBC12 found DSS reports backing up many resident claims dating back to 2013.
The most recent inspection happened on Nov. 13, when DSS found 20 violations.
A few of the violations were a bit shocking, such as this one that says:
Based on resident interview and facility documents, the facility failed to notify the licensing office, by the next working day reported any major incident that negatively affects or threatens the life, health, safety or welfare of any resident. Evidence: On 11/06/2017 while observing the physical plant, the Licensing Inspector observed that resident #10 had facial bruising and had sustained a head injury. The Virginia Department of Social Services did not receive any notification regarding resident #10's head injury.
Another one of the violations found was this:
Based on resident and staff interviews and facility documentation, the facility failed to ensure compliance with its own policies and procedures. Evidence: On 11/13/2017 while observing a medication administration pass, it was observed that resident #9 had a large purple and bluish facial bruise with extreme eye swelling. When interviewing the Administrator, the Administrator did not have knowledge of what happened. The Administrator then inquired to facility staff and confirmed with staff, the resident had a fall on 11/12/2017. According to the facility head injury protocol, a call for emergency services will be completed immediately. When the inspector arrived on 11/13/2017, a call for emergency services had not yet been made.
Our investigation also revealed a video of possible abuse being investigated by the Virginia Board Of Long-Term Care Administrators.
Melina Smith, a former resident, recorded the video after she says her elderly, non-verbal roommate was often bullied by a nurse at the facility.
“It's unbelievable the way people get treated. I wouldn't wish this on anybody,” Smith said. “I hope your investigation really opens someone's eyes because some of those people are literally voiceless.”
Just two weeks ago, the property where Jones & Jones is located was put up for sale online for $4.4 million.
Lastly, we reported earlier this month that Mable Jones, the administrator of Jones & Jones had her license suspended in June by the Virginia Board Of Long-Term Care Administrators and is currently on probation.
So how can a facility plagued with violations for years, cited by the Department Of Social Services, remain in operation?
“We are very limited as a government agency with what we can do,” Tara Ragland, the Division Director for Adult Licensing Programs with the Department of Social Services said.
Ragland has been with DSS for a little over a year.
“We have a set of regulations that are handed down to us by the General Assembly,” Ragland said.
Some of those regulations are possibly tying the agency's hands.
The Virginia code can be found here.
“No matter what my personal opinion is and what we can see on our website from three to five years ago, we are only allowed to look back for about a period of a year. That makes it difficult to pile on violations," said Ragland.
The code also appears to be lenient. There are no specific number of violations or particular types of violations that will automatically determine whether a facility's license is taken away. DSS also doesn't have authority to make a recommendation to deny a license until the end of the facility's licensure period.
According to DSS:
The inspection process provides an opportunity for the licensee to receive information on areas of noncompliance and devise a plan of correction to bring the facility into compliance.
- Regular inspection: Any on-site inspection by a licensing representative to a facility/program while a license is in effect to assess a licensee’s performance by determining compliance with a strategic sample of standards and investigating compliance with additional standards if potential noncompliance seems indicated in those areas.
- Plan of correction: The portion of the violation notice on which an applicant/licensee may provide a statement about how the cited violation(s) will be addressed in order to return the facility/program to compliance and maintain future compliance with applicable standard(s). Though the licensing representative may assist in the completion of this task – if appropriate and as time allows – it is ultimately the responsibility of the provider, who is solely liable for the success or failure of planned actions to return to and maintain compliance with program regulations.
- Focused inspection: When the licensing representative returns to a facility/program within a specified number of days in order to conduct a re-visit inspection that focuses on the specific area(s) of non-compliance cited at the most recent inspection.
There are no specific number of violations or particular types of violations that will automatically determine whether or not a license is taken away. There are multiple factors that are considered when making a final determination on the recommendation for a license or the denial of license.
When the option of consideration is for a denial of a license, additional factors of consideration include the following:
- Demonstrated substantial noncompliance during the current licensing period
- Failure to submit all items necessary to complete the application for renewed licensure
- Circumstances have changed so that it is unlikely that the licensee will be able to maintain compliance with standards in the next licensing period.
We are not able to change a particular license type until the end of the licensure period. Even if there is substantial noncompliance discovered during the middle of a licensure period, we do not have the authority to make a recommendation for a provisional license or the denial of a license until the end of the licensure period.
There are however options for consideration (listed below) for addressing noncompliance during the middle of a license period.
An intensive plan of correction (IPOC) can be recommended by licensing staff to address noncompliance that cannot be addressed through a plan of correction on a violation notice. Examples of noncompliance that might lead to an IPOC include insufficient staffing, medication errors, sanitation issues, poor records management, and concerns regarding the safety of residents in care.
An enforcement action can be recommended by licensing staff when providers violate laws and/or regulations in ways that negatively impact the health, safety, or welfare of adults in care.
Examples of types of recommended enforcement actions (during the middle of the licensure period) include the following:
- Reduction in licensed capacity
- Prohibition of new admissions
- Mandated training
- Civil penalty
- Requiring the licensee to contact the legal representatives/other responsible parties about health and safety violations
- Termination of public funding (auxiliary grant payments)
It is important to also keep in mind that the licensee is afforded an opportunity to appeal violations cited as well as enforcement actions. When appealing violations cited, we have a two-step process. In the first step review process, a licensee may appeal the findings of violations cited within 15 days of receiving the compliance plan. The licensing administrator is responsible for responding to the first step review.
If the licensee is not satisfied with the first response, a request can be made for a second step review within 15 days of receiving the first step response. The second step request is completed by staff in Home Office.
There is also an appeal process afforded to the licensee for enforcement actions. The licensee has 15 days from the date of receipt of the notice of the enforcement action to submit an appeal.
According to DSS, at one time, Jones & Jones was fined $4,500, but it was before Ragland's time.
Ragland says for the past six months, DSS has been investigating Jones & Jones.
“We've been able to work with interdisciplinary groups like law enforcement and city council who have been instrumental in trying to get the word out about what's going on at Jones & Jones,” Ragland said.
Ragland says the only way to enact true change is for people to make their voices heard by the General Assembly to get laws changed in Virginia. Last year, the governor signed into law an increase for the amount of civil penalties a facility can receive.
“We have to depend on the General Assembly and powers to be to do that, and that's why communication and focusing on these issues to get people involved is what needs to happen,” Ragland said.
With the next General Assembly session fast approaching, Ragland encourages anyone with an opinion about Jones & Jones, or any assisted living facility, to make their voices heard, encouraging lawmakers to make forever change for our most vulnerable population.
As of Feb. 1, the Department of Social Services is rolling out some new regulations. It's the first comprehensive revision to the regulations in over 20 years. It will include strengthening infection control requirements and more education for staff and administrators.
We have reached out to Mable Jones and her attorney for comment and have not heard back.
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