VIRGINIA DEPARTMENT OF SOCIAL SERVICES

First Colonial Inn ALF
845 First Colonial Road
Virginia beach, VA 23451
(757) 428-2884

Current Inspector: Margaret T Pittman (757) 641-0984

Inspection Date: May 10, 2021 , May 12, 2021 , May 13, 2021 and May 17, 2021

Complaint Related: No

Areas Reviewed:

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 EMERGENCY PREPAREDNESS

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 05-10-2021 and concluded on 05-17-2021. The Administrator was contacted by telephone to initiate the inspection. The Administrator reported that the current census was 62. The inspector emailed the Administrator a list of items required to complete the inspection. The inspector reviewed 4 resident records, 4 staff records, criminal background checks and sworn disclosures of newly hired staff, staff schedules, fire drills, fire and health inspection reports, dietary oversight, and healthcare oversight. Information gathered during the inspection determined non-compliances with applicable standards or law, and violations were documented on the violation notice issued to the facility.

Violations:

Standard #:	22VAC40-73-650-B
Description:	Based on record review and interview, the facility failed to ensure prescriber?s orders, both written and oral, for administration of all prescription and over-the-counter medications, identified the diagnosis or specific indications for administering each drug. Evidence: 1. Resident #1?s signed physician?s orders dated 03-19-2021 did not include a diagnosis or specific indications for Ditiazem 240mg; Tylenol w/Codeine 300-30mg; Robaxin 500mg; Butrans Transdermal patch 15 mcg/hr; Docusate 100mg; Flor-Con 10 MEQ; Soothe XP Opth Soln; Nitroglycerin Sublingual Tab 0.4mg; Omeprazole 40mg; Prednisone 5mg; Melatonin 5mg; and Lasix 20mg. 2. Staff #1 acknowledged resident #1?s aforementioned orders did not include the diagnosis or specific indications for administering the medications.
Plan of Correction:	Resident #1 Signed physician?s orders will have diagnosis approved a transcribed to EMAR for Diltiazem 240mg, Tylenol with Codeine 3---30mg, Robaxin 500mg, Butrans Transdermal patch 15mcg/hr., Docusate 100mg, Flor-Con10meq, Soothe XP ophthalmic solution, Nitroglycerin Sublingual tablets, Omeprazole 40mg, Prednisone 5mg, Melatonin 5mg, Lasix 20mg -prescriber notified diagnosis obtained during review. Staff will fulfill regulation as it pertains to ensuring prescribers orders both written and oral, identify the diagnosis or specific indication for administering the drug. RCS, ALD or designee will review all new orders daily to ensure continued compliance. RCS/ALD will audit all records to ensure that all RX, OTC identify the diagnosis condition or specific indication for usage.
Standard #:	22VAC40-73-650-C
Description:	Based on record review and interview, the facility failed to ensure the physician's oral orders are reviewed and signed by a physician within 14 days. Evidence: 1. The following physician?s oral orders were not reviewed and signed by a physician within the required timeframe: A. Resident #1?s orders dated 03-20-2021 for 2L of continuous oxygen, and 03-24-2021 for Tylenol Arthritis Strength 650mg were not reviewed and signed by a physician as of 05-17-2021. B. Resident #4?s orders for Tramadol 50mg (order dated 02-21-2021); Calmoseptine Ointment (order dated 03-03-2021); Immodium 2mg and Floraster 250mg (orders dated 03-05-2021); Triad paste (order dated 04-02-2021); and Triamcinolone 0.1% cream (order dated 04-18-2021) were not reviewed and signed by a physician as of 05-17-2021. 2. Staff #1 did not provide documentation of a physician?s signature within 14 days for the aforementioned oral orders. 3. Staff #1 acknowledged the aforementioned oral orders were not reviewed and signed by a physician within the required timeframe.
Plan of Correction:	Residents #1 & # 4- All telephone orders written by Hospice nurse will be reviewed and signed by Hospice Physician. Staff will fulfill the regulation as it pertains to ensuring oral orders are reviewed and signed by physician within 14 days. ALD, RCS or designee will ensure Hospice nurse will flag new orders written at each visit for review. ALD RCS will review all oral orders and fax to physician within 24 hours for review and signature. RCS or designee will audit current records to ensure compliance.
Standard #:	22VAC40-73-650-F
Description:	Based on record review and interview, the facility failed to ensure whenever a resident is admitted to a hospital for treatment, new orders are obtained for all medications prior to or at the time of return to the facility. The facility did not document any contact with the physician regarding the new orders. Evidence: 1. Resident #2?s hospital ?Discharge Summary? dated 03-19-2021, instructed to start Cefdinir (Omnicef) 300mg. 2. Staff #2 stated the facility ?did not obtain? new orders for resident #2?s aforementioned medication prior to or at the time the resident returned to the facility on 03-19-2021. 3. Resident #3?s hospital ?Discharge Summary Notes? dated 04-17-2021, instructed to start Amoxicillin-clavulanate (Augmentin) 75-125mg and Lactobacillus Acidophilus 1 billion. 4. Staff #2 stated the facility ?only obtained orders from hospital? and did not obtain new orders for resident #3?s aforementioned medications prior to or at the time the resident returned to the facility on 04-17-2021. 5. Staff #2 did not provide documentation of contact made to resident #2 and resident #3?s primary physicians regarding the aforementioned new orders prior to or at the time of the resident?s return to the facility. 6. Staff #1 and staff #2 acknowledged the facility did not obtain nor notify resident #2 and resident #3?s primary physicians of the new aforementioned medication orders prior to or at the time of the residents return to the facility.
Plan of Correction:	Resident #2 & 3 ? orders were confirmed and reconciled by PCP as of 5/25/21. Staff will fulfill the regulation as it pertains to hospital returns to the facility that all new medication /treatment orders will be obtained prior to or at the time of return to facility. All orders coming from hospital will be sent to physician prior to or at time of admission and confirmed through documentation of notification as well as any changes. RCS/ALD will review for completeness. All staff who perform charge positions will be trained on the process. Random audits will be performed by Resident Care Supervisor/ALD or designee to ensure compliance.
Standard #:	22VAC40-73-680-D
Description:	Based on record review and interview, the facility failed to administer medications in accordance with the physician's instructions. 1. Resident #3?s signed physician?s orders from the hospital dated 04-17-2021 documented ?Amoxicillin-Clavulanate (Augmentin) - Take 1 tab by mouth every 12 hours for 7 days. Qty: 14 tab.? 2. Resident #3?s April 2021 Medication Administration Record (MAR) documented staff administered Amox/K Clav 875-125 twice daily on 04-18-2021 through 04-23-2021, and one dose in the morning on 04-24-2021. The resident did not receive the last evening dose of Amox/K Clav 875-125 on 04-24-2021. 3. Staff #1 and staff #2 could not provide documentation that the last dose of Amox/K Clav 875-125 was administered to resident #3. 4. Resident #4?s signed physician?s order dated 04-07-2021 documented ?Nystatin Cream 100,000 u/gm- Apply topically to mid and right chest rash BID [twice a day] x 14d for Candidiasis.? 5. Resident #4?s April 2021 MAR documented staff administered Nystatin cream 100,000 twice daily for 15 days on 04-08-2021 through 04-22-2021. 6. Staff #1 and staff #2 acknowledged the aforementioned medications for resident #3 and resident #4 were not administered in accordance with the physician?s instructions.
Plan of Correction:	Resident # 3 Augmentin - After further interview with team by recently hired ALD revealed that resident had received first dose of Augmentin prior to being discharged. Staff will fulfill the regulation as it pertains to administration of medication accordance to physicians? instructions. All medication orders will be reviewed and reconciled to EMAR with 24 hours of new orders by RCS or designee for accuracy. RMAs will be re-educated on the 5 rights of medication administration. RCS/ALD or designee will audit all current physician?s orders to ensure orders are reviewed and appropriate to the orders given.