VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Adult Care Center of the Northern Shenandoah Valley, Inc.
411 N. Cameron Street
Suite 100
Winchester, VA 22601
(540) 722-2273

Current Inspector: Jill James (540) 418-2631

Inspection Date: April 20, 2021 and April 21, 2021

Complaint Related: No

Areas Reviewed:

22VAC40-61 GENERAL PROVISIONS 22VAC40-61 ADMINISTRATION 22VAC40-61 PERSONNEL 22VAC40-61 SUPERVISION 22VAC40-61 ADMISSION, RETENTION, AND DISCHARGE 22VAC40-61 PROGRAMS AND SERVICES 22VAC40-61 BUILDINGS AND GROUNDS 22VAC40-61 EMERGENCY PREPAREDNESS 63.2 General Provisions. 22VAC40-90 Background Checks for Assisted Living Facilities 22VAC40-90 The Sworn Statement or Affirmation 22VAC40-90 The Criminal History Record Report

Technical Assistance:

1) Ensure all nursing staff are in-serviced on standard 300, including what information must be on the medication administration records. 2) Once received, ensure the final typed copy of the violation notice is posted in place of the Acknowledgement Form.

Comments:

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 4/20/21 and concluded on 4/21/21. The director was contacted by telephone to initiate the inspection. There were 12 participants present and eight staff on duty. The inspector emailed the director a list of items required to complete the inspection. The inspector reviewed two participants' records and two staff records submitted by the facility to ensure documentation was complete. Selected sections of two additional participant and two additional staff records were also reviewed. In addition, a virtual tour was conducted during this inspection. Information gathered during the inspection determined non-compliance with applicable standards or law and a violation was documented on the violation notice issued to the facility. The licensing inspector has reviewed with the director COVID-19 guidance posted on the ADCC webpage.

Violations:

Standard #:	22VAC40-61-300-E-7-d
Description:	1) The March and April medication administration records (MARs) for participants B and D did not include a diagnosis for the medications listed. 2) On 4/21/21, the licensing inspector interviewed the director who stated she checked the MARs and they did not include the diagnosis for the medications that were listed.
Plan of Correction:	Each participant administered a medication while at the center will have a MAR which includes the individual's diagnosis for each medication. The registered nurse (RN) will write the diagnosis for each medication on each new MAR. To avoid a reoccurrence, documentation of the diagnosis will be reviewed by a different RN monthly and one specific RN will be assigned to review all MARs monthly a second time to ensure compliance.