VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Mountain View Retirement Home
2336 Coal Tipple Hollow
Lebanon, VA 24266
(276) 889-3611

Current Inspector: Crystal Mullins (276) 608-1067

Inspection Date: Feb. 9, 2022

Complaint Related: No

Areas Reviewed:

22VAC40-73 GENERAL PROVISIONS 22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES 22VAC40-73 PERSONNEL 22VAC40-73 STAFFING AND SUPERVISION 22VAC40-73 ADMISSION, RETENTION, AND DISCHARGE OF RESIDENTS 22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-73 RESIDENT ACCOMODATIONS AND RELATED PROVISIONS 22VAC40-73 BUILDING AND GROUNDS 22VAC40-73 EMERGENCY PREPAREDNESS

Comments:

Two licensing inspectors conducted an unannounced one day renewal inspection at Mountain View Retirement Home on 02/09/2022. The inspection began at 10:35am and concluded at 2:34pm. The facility had 36 residents in care on the day of the inspection. The licensing inspectors observed lunch, the noon med-pass, the building, resident and staff interactions, activities, and resident and staff files. An exit meeting was held with the administrator of the facility on the day of the inspection. At that time an opportunity was given to find items that were not in the files. As a result of this inspection five violations are being cited. Please develop a plan of correction for each violation cited along with a dated of correction and return a signed and dated copy back to your licensing inspector within 10 calendar days (02/25/2022). If you have any questions or concerns please feel free to contact your licensing inspector at 276-608-1067. Thank you for your assistance and cooperation.

Violations:

Standard #:	22VAC40-73-50-A
Description:	Based on observations made during documentation review, the facility failed to use the most current form developed by the department. EVIDENCE: 1. Resident # 2 and #4 did not have the most current disclosure form developed by the department.
Plan of Correction:	A new department approved disclosure statement will be developed and used in the future. [sic]
Standard #:	22VAC40-73-320-A
Description:	Based on observations made during documentation review, the facility failed to have an independent physician specify whether an individual is or is not capable of self-administering medications and including reactions to allergies listed on the physical. EVIDENCE: 1. Resident #7 has a physical completed on 04/02/2021, there was not a statement in the file or on the physical stating whether or not the resident is capable of self-administering medications nor is their reactions to allergies listed.
Plan of Correction:	A statement will be in the resident's file stating whether she can self administer medication. Also a statement of any reactions to allergies. In the future facility will be aware of any outside physical forms containing correct information. [sic]
Standard #:	22VAC40-73-440-H
Description:	Based on observations made during documentation review, the facility failed to complete an annual reassessment of the Uniform Assessment Instrument (UAI) for one resident. EVIDENCE: 1. Resident #1 was admitted to the facility on 07/16/2019. The most current UAI in Resident #1's file was dated 01/02/2021.
Plan of Correction:	A current UAI will be completed and will be maintained correct in the future. [sic]
Standard #:	22VAC40-73-450-C
Description:	Based on observations made during documentation review, the facility failed to include a description of identified needs on the Individualized Service Plan (ISP) based upon needs identified on the the Uniform Assessment Instrument (UAI). EVIDNECE: 1. Resident #1 has a UAI dated 01/20/2021; this UAI identifies the resident wanders passively, less than weekly and the resident is disoriented to some spheres, some of the time. The ISP dated 07/20/2021 documents Resident #1 as being oriented and also documents an appropriate behavior pattern, these are inconsistencies.
Plan of Correction:	A correction was made to the ISP and the ISP was updated to address the inconsistencies. In the future facility will be more cognizant to this error. [sic]
Standard #:	22VAC40-73-680-M
Description:	Based on observations made during the medication cart audit, the facility failed to ensure medications ordered for PRN administration shall be available. EVIDENCE: 1. Resident #8 is prescribed Acetaminophen 325 mg tablets, take two tablets by mouth very six hours as needed for pain. This medication was not available on the medication cart.
Plan of Correction:	Medication was ordered by facility in the future facility will maintain all prescribed medications. [sic]