By Norfolk Senior Advisor Care Team · September 12, 2026
- Medication plans, individualized service plans and physical exam reports top the list of citations in VDSS violation notices from the last 24 months.
- Most citations concern paperwork: unsigned plans, late forms, missing records. Paperwork is how you can tell whether care is being planned and checked.
- A citation is a question to ask, not a verdict. Read the actual notice and check whether the same standard repeats.
Which assisted living violations are cited most often in Hampton Roads?
In VDSS violation notices from the last 24 months across the area's 84 licensed facilities, the most cited standard was the medication management plan, with 33 citations. Subsections of the individualized service plan rule together drew 92, and the physical examination report drew 26. The sample covers up to four violation inspections per facility.
Read the numbers carefully. They count citations, not facilities, so one building cited repeatedly counts repeatedly. They come from VDSS records pulled October 28, 2026, and a citation means an inspector found a written standard unmet on that visit, not that a resident was harmed.
Most of the top items are about records, because records are what an inspector can verify. A plan that exists on paper and is signed and dated is evidence that someone thought about your parent, and a missing one is the first thing to ask about on a tour.
| Standard | Plain meaning | Citations |
|---|---|---|
| Individualized service plan (22VAC40-73-450, four subsections) | The written care plan | 92 |
| Medication management plan (-640-A) | How the facility handles medications | 33 |
| Medication administration (-680-D and -680-I) | Giving medications as ordered and recording them | 30 |
| Physical examination report (-320-A) | The doctor's report before admission | 26 |
| Staff records and health (-250-D) | Staff health screening files | 18 |
| First aid and CPR (-260-A) | Trained staff on every shift | 18 |
What do medication citations at Virginia assisted living facilities mean for families?
A medication management plan citation under 22VAC40-73-640-A means a facility's written plan left out something the rule requires, such as how new orders are copied to the medication administration record (MAR) within 24 hours, how refills are timed to avoid missed doses, or how staff giving medication are observed.
Citations under 22VAC40-73-680 concern the act itself. Subsection D requires medications to be given as the prescriber ordered, and subsection I lists what every MAR entry must show, including the drug, dose, time given, staff initials, any error or omission, and for as-needed medications the symptom and whether it worked.
For your family, ask to see a blank MAR and the facility's medication plan. Ask how you would be told about a missed dose or a change in orders. Ask who gives medications on nights and weekends, and whether that person is a medication aide. A facility that answers easily is usually a facility that has practiced the answers.
What do individualized service plan citations mean for a Hampton Roads family?
An individualized service plan (ISP) is the written plan of what help your parent gets, when, and from whom. Citations under 22VAC40-73-450 usually mean the plan was late, unsigned, incomplete or not updated. Together its subsections drew more citations than any other standard in the Hampton Roads sample.
The timeline is specific. A preliminary plan is due on or within seven days before admission. The full plan is due within 30 days of admission. It must be signed and dated by the facility and by your parent or legal representative, list who contributed, and be reviewed at least every 12 months and whenever your parent's condition changes significantly.
Ask for a copy, and ask to join the annual review. After a fall or hospital stay, ask for an update in writing. Related citations include the Uniform Assessment Instrument (UAI) rule, with 13 citations, and the fall risk rating rule, with 12. See our UAI guide.
Why do physical exam, staff record and CPR citations matter to Virginia families?
They show whether the facility checked that it could safely take your parent and whether trained people are on duty. The admission physical exam must be done by an independent physician within the 30 days before admission, and a citation under 22VAC40-73-320-A usually means the report was missing, late or incomplete.
The report must include items such as allergies, a tuberculosis risk assessment, whether the person walks independently and whether they can take their own medication. The facility relies on it to decide what care to plan, so a thin report can mean a thin plan. Staff record citations under -250-D concern health information, including a tuberculosis risk assessment within seven days before a staff member's first day and an annual one after.
First aid and CPR rules require current certification for direct care staff, with first aid within 60 days of hire unless the person is a nurse or emergency medical technician, and at least one CPR-certified person in each building at all times. Ask who holds CPR on the overnight shift.
What do menu, resident rights and background check citations mean in Virginia?
A menu citation under 22VAC40-73-610-B means the weekly menu was not dated and posted where residents can see it, substitutions were not recorded, or two years of served menus were not kept. A resident rights citation under -550-G means the annual review of rights lacked signed acknowledgments.
The background check standard, 22VAC40-90-40-B, requires a criminal history record report within 30 days of employment. It drew 16 citations. Another subsection bars unsupervised resident contact until the report is received. Ask how a new hire is supervised in the first month, and how long hiring takes.
Check the menu on the wall during a tour. Second servings and snacks must be available at no extra charge, and one meal a day must include a hot main dish. For rights, ask for the residents' rights notice and confirm that your parent receives an annual review. If a right is not honored, the ombudsman can help; see complaints and the ombudsman.
How should Hampton Roads families use citation counts when comparing assisted living?
Treat a citation as a prompt for questions. Read the facility's notices on the VDSS public search, see whether the same standard repeats across inspections, and read the plan of correction. One late form is different from the same medication citation appearing visit after visit.
Size affects counts. A building with more residents and more staff has more records to check, so a larger facility can collect more citations without being worse. Compare notices for what they describe, not how many there are, and ask the administrator what changed after each one.
License terms add context. Of the 84 facilities, VDSS records show 50 on a one-year license, 27 on a two-year, 2 on a three-year and 5 conditional. VDSS describes a two-year license as going to a facility that complies on a sustained basis and exceeds the minimum in some areas. See reading VDSS inspection reports and the assisted living directory.
Frequently asked questions
Does a citation mean a resident was hurt?
No. A citation means an inspector found a standard unmet at the time of the visit. Many concern documents. Some involve real risk, so read what the notice says happened and whether the facility's plan of correction fixed it.
Can a good facility have citations?
Yes. Nearly every facility with repeated inspections collects some, and larger buildings have more records to check. Look for patterns: the same medication or supervision problem across several visits matters more than one missed signature.
Where do I read a facility's violation notices?
On the VDSS public assisted living search, which posts inspection findings including violation notices. The most recent findings must also be posted inside the facility, so you can ask the administrator to show you the copy on a tour.
Who do I call if I see a problem in person?
Call the VDSS complaint line at 1-800-543-7545 for licensing violations, and Adult Protective Services at 888-832-3858 if you suspect abuse, neglect or exploitation. The regional ombudsman also helps residents, with their consent. Call 911 first in an emergency.
