VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Kings Grant Retirement Community-Craig Assisted Living
350 Kings Way Rd.
Martinsville, VA 24112-6631
(276) 634-1000

Current Inspector: Holly Copeland (540) 309-5982

Inspection Date: July 9, 2024

Complaint Related: No

Areas Reviewed:

22VAC40-73 RESIDENT CARE AND RELATED SERVICES

Comments:

Type of inspection: Monitoring Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 07/09/2024 from 11:00 AM until 12:45 PM The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. A self-reported incident was received by VDSS Division of Licensing on 06/23/2024 regarding allegations in the area(s) of: Resident care and related services. Number of residents present at the facility at the beginning of the inspection: 57 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 1 Number of staff records reviewed: 1 Number of interviews conducted with residents: 0 Number of interviews conducted with staff: 2 Observations by licensing inspector: N/A Additional Comments/Discussion: N/A An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation supported some, but not all of the self-report; area(s) of non-compliance with standard(s) or law were: Resident care and relate services. A violation notice was issued; any violation(s) not related to the self-report but identified during the course of the investigation can also be found on the violation notice. The licensee has the opportunity to submit a plan of correction to indicate how the cited violation(s) will be addressed in order to return the facility to compliance and maintain future compliance with applicable standard(s) or law. If the licensee wishes to provide a plan of correction: (i) type the plan on a separate Word document, (ii) identify the standard violation number being addressed, (iii) include the date the violation will be corrected, (IV) do not include any names or confidential information, and (V) return to the licensing inspector by email within five (5) business days of the exit interview. Compliance with all applicable regulations and law shall be maintained and any areas of noncompliance must be corrected. Within 15 calendar days of your receipt of the inspection findings (inspection summary, violation notice, and supplemental information), you may request a review and discussion of these findings with the inspector's immediate supervisor. To make a request for review and discussion, you must contact the licensing supervisor at the regional licensing office that serves your geographical area. Regardless of whether a supervisory review has been requested, the results of the inspection will be posted to the DSS public website within 5 business days of your receipt of the Inspection Summary and/ or Violation Notice. The department's inspection findings are subject to public disclosure. Please Note: A copy of the findings of the most recent inspection are required to be posted on the premises of the facility. For more information about the VDSS Licensing Programs, please visit: www.dss.virginia.gov Should you have any questions, please contact Holly Copeland, Licensing Inspector at 540-309-5982 or by email at holly.copeland@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-550-C
Description:	Based on record review and staff interview, the facility failed to ensure that any resident of an assisted living facility has the rights and responsibilities as provided in ? 63.2-1808 of the Code of Virginia and this chapter, specifically regarding that a resident is to be treated with courtesy, respect, and consideration as a person of worth, sensitivity, and dignity (11). EVIDENCE: 1. A facility reported incident, submitted to LI on 06/23/2024, indicated that on the evening of 06/21/2024, staff 1 reported to staff 3 that while staff 1 and staff 2 were working in the safe, secure unit assisting resident 1 with toileting, resident 1 smeared a wipe covered with feces onto staff 1?s face. 2. The LI?s review of healthcare provider notes for resident 1, dated 06/21/2024, reveal that resident 1 has a diagnosis of ?dementia of the Alzheimer type with behavioral disturbance? with an onset date of 05/15/2022. The uniform assessment instrument and individualized service plan for resident 1, both completed 05/26/2024, indicate that resident 1 requires mechanical assistance (rails) and physical assistance of staff with toileting, has abusive/aggressive/disruptive combative behaviors less than weekly, and is disoriented to time and place all of the time. 3. Per a documented facility interview with staff 1 on 06/30/2024, her initial reaction to resident 1 touching staff 1?s face with a wipe covered in feces was for staff 1 to take the clean wipe that was in her own hand and touch resident 1?s face with it. Upon further reflection about the incident, staff 1 was concerned that it might have been considered abuse to resident 1; therefore, staff 1 reported herself to staff 3. 4. The facility?s documented interview with staff 2 confirmed that staff 1 and staff 2 were assisting resident 1 with toileting and resident 1 took a wipe with feces on it and touched staff 1 in the face with it. Staff 2 revealed that at that moment, she quickly moved out of the way and turned her head, so staff 2 did not observe staff 1 touch resident 1 in the face with a clean wipe. 5. The facility?s incident report indicates that as a result of staff 1?s self-report, the facility placed staff 1 on leave indefinitely until staff 4 and staff 5 return on 07/01/2024 to investigate. 6. Per the LI?s interview with staff 4 and staff 5 on 07/09/2024 and documentation from the finalized self-report, a final written warning notice was issued, and disciplinary action was taken against staff 1 due to the incident of putting a clean wipe to resident 1?s face in response to resident 1 putting a fecal-soiled wipe to staff 1?s face. In addition, per the LI?s interview with staff 4 and staff 5 and a review of staff 1?s record, a detailed remedial action plan will be implemented immediately and over the course of the next six months.
Plan of Correction:	1. Nursing Supervisor Spoke with Staff #1 regarding response to behavior event involving dementia resident #1. Employee self-reported her response of placing a clean wipe in Resident #1 face. Employee suspended pending investigation. (06/30/2024) 2. Investigation revealed no other witness to this self-reported Employee #1 response. Employee #2 who was in the room had stepped back and turned head during event and therefore did not witness this self-reported reaction from Employee #1. Employee #1 has voiced extreme remorse and concern over this self-reported response. Employee #1 had a prior clean Personnel work history with no other issues previously noted in her 13- year work history. In addition, Employee #1 had numerous praise accolades from other staff and residents on her behalf during her past work history and current investigation. Employee #1 presented this self-report seeking personal help from the Supervisor #3 with stress management and employee burn-out. (07/01/2024) 3. Employee #1 was provided a Final Step III Disciplinary Warning along with a week- long Unpaid suspension. Employee#1 was removed from working on the Memory Care Unit. Employee #1 to now be assigned to Healthcare and Assisted Living Units instead with assignments geared more towards alert and oriented resident with capabilities to voice and self-report any further concerns. Step III warning notes that any further such related employee action will result in immediate termination. Employee #1 was encouraged to lessen her other work assignments outside KG to decrease work hours and job stress, lessen stress and overall improve her self-esteem and general outlook. Employee #1 was assigned 16 RELIAS online training courses covering topics of abuse, dementia behaviors, workforce positivity, stress relief, enhanced communications and improved teamwork. Employee #1 will write a 1- page report on each topic to be reviewed in monthly meetings with DON and LNHA ongoing for the next 6 months. (02/28/2025) 4. All staff provided abuse training in staff meeting huddles. All Staff to be provided with 6- week ongoing series training from Teepa Snow?s Positive Approach to Care ? Getting to Know Dementia which covers various aspects of dementia training including challenging behaviors in dementia care. In addition, Memory Neighborhood Staff to obtain the EVERGREEN Dementia Care Specialist Certification. All staff provided EAP resources and stress reduction techniques as needed. (08/09/2024) 5. Ongoing follow -up and observation of Employee #1 work performance, coworker communications, and resident interactions. Staff member status, her training, and All staff training plan to be followed by our quarterly QAPI team meetings.