SAINT FRANCIS HOME DISCLOSURE STATEMENT
As required for licensed Assisted Living Facilities by
The Virginia Department of Social Services
Latest Update: December 1, 2015
FOR ACCESS BY THE GENERAL PUBLIC: www.saintfrancishome.com
1. Name of the assisted living facility:
Saint Francis Home
2. Name of the licensee:
Saint Francis Home, Inc.
3. Names of any other assisted living facilities for which the licensee has a current license issued by the Commonwealth of Virginia:
None
4. Ownership structure of the facility, i.e. individual partnership, corporation, limited liability company, unincorporated association or public agency:
501 (c) 3 Nonprofit (Catholic Diocese of Richmond)
5. Name of the management company that operates the facility, if other than the licensee:
Saint Francis Home is self-managed
6. Licensed capacity of the facility:
135
7. Description of the characteristics of the resident population, such as general information on gender, age, medical condition, mental status, special populations, and social or other relevant descriptors:
· The primary population served by Saint Francis Home is mature to elderly men and women of limited financial means.
· The resident population [12/31/15] is 62% Women, 38% men, 85% age 60 or older, the oldest 98, the youngest 56, and the average age 76.
· Medical conditions of residents would be comparable to similar age groups and social-economic segment of the general population. No chronic medical conditions among residents require skilled care.
SFH DISCLOSURE STATEMENT: DSS-- 12/28/05 Last Updated 12/15 1
Saint Francis Home / 65 W. Clopton Street / Richmond, VA 23225 / 804-231-1043
· The mental status of the resident population includes:
Individuals who are mentally alert with minimal cognitive impairment;
Individuals with mild memory impairment, dementia, and early to middle stages of Alzheimer’s;
Individuals with mental retardation; and
Individuals with a history of substance abuse.
· The resident population does not include individuals whose behavior is aggressive, abusive or presents a danger to self or others.
8. Description of accommodations, services, and care that the facility offers and related fees. Specify the base fee and indicate that which is included in the base fee. If there are different base fees for different levels, graduations or types of care, indicate the base fee for each level separately and specify the accommodations, care and services included under each level.
Base Fees:
i. For 81 beds in David Cran, Jordan Ligouri, and Vesey areas of the facility:
· Auxiliary Grant Rate (Currently $1219 per month)
ii. For 44 beds in the Sullivan Place area of the facility at Private Pay base rates ranging from $1850 to $2500 per month.
Accommodations, included in the base fees:
iii. Resident accommodations for Base Fee in David Cran, Jordan Ligouri and Vesey areas consist of private or double-occupancy rooms with private or multi-resident-use baths.
iv. Accommodations for Base Fee in Sullivan Place area consist of private rooms and suites with private or semi-private baths.
Services included in the base fees:
All of the base fees include the following services at no additional charge:
· Instrumental Activities of Daily Living including,
1. All meals and three snacks daily
2. Daily housekeeping
3. Linen Services
4. Management of finances
5. Personal Laundry Services
· Medication management and administration.
· Assistance with Activities of Daily Living.
SFH DISCLOSURE STATEMENT: DSS—12/28/05 Last Update 12/15 2
Saint Francis Home / 65 W. Clopton Street / Richmond, VA 23225 / 804-231-1043
· Full schedule of activities and programs.
· Assistance in arranging transportation for medical appointments.
Additional accommodations, services, and care not included in the base fee and fee for each:
1. Private telephone at $20.00 per month
2. Cable Television at $19.00 per month
3. Beauty Shop, and Podiatrist
9. Policy regarding increase in charges and length of time for advanced notice of intent to increase charge:
Monthly fee may be increased no more than once annually at a maximum increase of 3% with advanced written notice of at least thirty (30) days.
10. Amount of advance or deposit payment and refund policy:
A $500 non-refundable Community Fee is required for most all private-pay residents.
11. Criteria for admission to the facility and any restrictions on admission:
In addition to meeting admission criteria and restrictions pursuant to 22 VAC 40-71-150, applicants are required to be:
a. Ambulatory or semi-mobile (meaning they are independently mobile with the assistance of a walker or wheelchair),
b. Able to transfer (meaning able to independently move from a seated position to an other seated surface or bed),
c. Capable of independent mobility to and from dining room, throughout the facility and to exit the building in emergency situation,
d. Able to eat meals without assistance,
e. Capable of doing their own toileting,
f. At least 50 years old (exceptions may be made based on individual basis regarding special needs and compatibility with older population).
A Restriction on admission includes individuals who:
a. Are abusive, aggressive, or present a threat to self or others,
b. Are noncompliant with psychotropic medications,
c. Present immediate and serious risk to the health, safety or welfare of others,
d. Have care needs exceeding capabilities of staff or facility. This includes residents with orders for gastric tubes.
e. Have diagnoses of schizophrenia, bipolar or severe cognitive impairment.
12. Criteria for transfer to a different living area within the same facility, including transfer to another level graduation, or type of care within the same facility or complex:
i. Private-pay residents who can no longer afford monthly rate would be moved [upon availability] to Vesey, Jordan Ligouri or David Cran areas @ Auxiliary Grant rate or double occupancy on Sullivan Place or
SFH DISCLOSURE STATEMENT: DSS—12/28/05 Last Updated 12/15 3 Saint Francis Home / 65 W. Clopton Street / Richmond, VA. 23225 / 804-231-1043
affordable private-pay rate (at or above current AG rate).
ii. A resident may be transferred to accommodate mobility limitations (for instance moved to a room closer to the dining room).
iii. A resident may be transferred because of personality problems between roommates or another resident.
iv. There is no care level differential areas (residential vs. assisted).
v. One year minimum at private pay rate before transfer.
13. Criteria for discharge from the facility, including the actions, circumstances, or conditions that would result or might result in discharge of the resident.
i. Changes in physical, emotional or mental condition requiring a higher level of care.
ii. Care needs that are beyond skills or capabilities of staff.
iii. Conditions presenting health risk to others.
iv. Behavior presenting risk of physical harm or danger to self or others.
v. Noncompliance with facility’s medication plan and policies, or licensing standards for medication management and administration.
vi. Noncompliance with facility’s written policies and rules.
vii. Noncompliance with Individual Service Plan.
viii. Nonpayment of fees and charges for accommodations and related services.
ix. Damage to facility and/or property of Saint Francis Home, Inc.
x. Noncompliance with general grooming and incontinence care presenting health risks to themselves or others.
14. Requirements or rules regarding resident conduct and other restrictions and special conditions.
i. Residents are expected to treat fellow residents with respect and dignity.
ii. Residents must comply with written rules, policies and established standards regarding conduct and social interaction among residents and staff.
iii. Saint Francis Home is a smoke-free facility. Residents (and all others) must comply with smoking restrictions.
SFH DISCLOSURE STATEMENT: DSS—12/28/05 Last Updates 12/15 4
Saint Francis Home / 65 W. Clopton Street / Richmond, VA 23225 / 804-231-1043
Average per week
· Exercise Class 2
· Social 3
· Religious 7
· Entertainment 1
· Participatory-games 9
· Outings 1/2
· Cultural 4
· Semi-annual Field Trips
Frequency of activities (average per week) 26
Range of activities: Note whether all activities are available to all residents or what, if any, limitations are placed on participation in specified activities. Note whether participation in certain activities is geared to a particular group of residents.
· Physical fitness exercise class.
· Physical fitness participation requires written approval by physician.
Some activities, although not restricted to any residents, are geared to particular groups, i.e. memory lane and word game to those with memory loss.
15. Staffing on each shift:
First shift 7:00am-3:00pm General number of staff 21-23
Direct care 5
i. Functions of staff:
a. Administration
1 Administrator: 7:00am-4pm
1 Director of Finance: 9:30am-5:30pm
1 Executive Director/Project Manager: Flexible
b. Activities
1 Director: 8:30am-4:30pm
c. Food Service
1 Food Service Manager: 7am-5pm
2 Cook: 6am-2pm
4 Assistants/Servers: 7am-3pm
d. Physical Plant
5 Housekeepers: 8am-4pm
2 Custodian/Maintenance: 8am-4pm
SFH DISCLOSURE STATEMENT: DSS—12/28/05 Last Updated 12/15 5
Saint Francis Home / 65 W. Clopton Street / Richmond, VA 23225 / 804-231-1043
e. Direct Care
4 Medication Aides: 7am-3pm
1 Resident Care Aides: 6am-23pm
(Resident Care/Transportation: 7am-3pm included)
ii. Qualifications of Staff:
1. Administrative Staff: Administrator-Licensed Nursing Home Administrator. Qualifications and experience of other administrative staff specific to responsibilities and duties performed.
2. Activity Director: Trained On-The-Job.
3. Food Service Manager: Manager is Certified, qualifications and experience of cooks and servers specific to responsibilities and duties performed.
4. Director Physical Plant: Licensed Master Electrician
5. Housekeeping, Laundry and Maintenance Director: Class A Contractor License. All other departmental staff trained and experienced in responsibilities and duties.
6. Business Office Manager: Certified Bookkeeper.
7. Direct Care Staff:
a. Director Healthcare Services: Registered Nurse directs resident care staff and all resident assisted care and services.
b. Registered Med Techs: Administers medications ordered by physicians.
c. Resident Care Aides: CNA or completion of DSS approved direct care training. Experience and training specific to resident care and services performed.
d. Medication Aides: Completion of Medication Management and Administration training as approved and certified by Virginia Board of Nursing, and CNA or completion of DSS approved Direct Care Training.
Second Shift: 3:00pm-11:00pm General Number of Staff 12-14
Direct Care 5
SFH DISCLOSURE STATEMENT: DSS—12/28/05 Last Updated 12/15 6
Saint Francis Home / 65 W. Clopton Street / Richmond, VA 23225 / 804-231-1043
i. Functions of Staff
Administration
1 until 4:30 pm
1 until 5pm
1 until 5:30pm
1 Until 6pm (2 days a week)
Activities
1 Until 5pm (except for special events)
Physical Plant
1 Maintenance until 5pm
Food Service
1 Cook 11am-7pm
1 Assistant 2 pm-8pm
Communications Dispatcher
1 4pm-12 midnight
Direct Care
4 Medication Aides 3pm-11pm
1 Resident Care Aides 3pm-11pm
ii. Qualifications of Staff
Communications Dispatcher: Trained and experienced in emergency procedures and direct care. All other functions-Qualifications as first shift.
Third Shift: 11pm – 7am General number of staff 2
2 Medicine Aides
Functions of Staff:
a. Communications Dispatcher: To receive and direct guests, answer telephone, monitor nurse call, secure facility, respond to emergency situations, and assist in resident care.
b. Resident Care Staff: (Medication Administration) to assist residents, make hourly rounds, respond to calls from residents, and respond to emergency situations.
Qualifications of Staff:
a. Communications Dispatcher: Trained and experienced in emergency procedures and direct care.
b. Resident Care Staff: Qualifications as first and second shift.
16. List any essential services to residents that are provided by contractors, such as staffing services, pharmacy services, healthcare services, and food services, among others:
SFH DISCLOSURE STATEMENT: DSS—12/28/05 Last Updated 12/15 7
Saint Francis Home / 65 W. Clopton Street / Richmond, VA 23225 / 804-231-1043
Pharmacy Services – Cedarfield Pharmacy
Podiatry Services – Dr. Russell Earnest
Physician Consultant – Dr. Iraj Mirshahi
Registered Nutritionist Consultant – Candice Collins
17. The facility maintains liability insurance that provides a minimum of $500,000 per occurrence and $500,000 aggregate to compensate residents or other individuals for injuries or losses from negligent acts of the facility.
18. Additional information about the facility may be obtained from the Virginia Department of Social Services’ website, which is http://www.dss.virginia.gov The information on the website includes type of license, special services, and compliance history after July 1, 2003.
19. Public Access to the Disclosure Statement and additional information about the facility may be obtained from the Saint Francis Home website, which is www.saintfrancishome.com.
SFH DISCLOSURE STATEMENT: DSS—12/28/05 Last Updated 12/15 8
Saint Francis Home / 65 W. Clopton Street / Richmond, VA 23225 / 804-231-1042