VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Riverside Assisted Living at Warwick Forest
860 Denbigh Blvd.
Newport news, VA 23602
(757) 886-2000

Current Inspector: Willie Barnes (757) 439-6815

Inspection Date: April 16, 2024 , April 17, 2024 and April 25, 2024

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 RESIDENT ACCOMMODATIONS AND RELATED PROVISIONS 22VAC40-73 BUILDINGS AND GROUND 22VAC40-73 EMERGENCY PREPAREDNESS 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS 22VAC40-90 BACKGROUND CHECKS FOR ASSISTED LIVING FACILITIES 22VAC40-90 THE SWORN STATEMENT OR AFFIRMATION 22VAC40-90 THE CRIMINAL HISTORY RECORD REPORT 22VAC40-80 THE LICENSING PROCESS

Comments:

Type of inspection: Monitoring An on-site mandated monitoring inspection conducted on 4-16-24 (Ar 07:15/dep 5:40 p.m.); 4-17-24 (Ar 08:39/dep 15:43) and 4-25-24 (Ar 08:39/Dep 11:20 a.m.. The facility census was 115. The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. An exit meeting will be conducted to review the inspection findings. The evidence gathered during the inspection determined non-compliance with applicable standard(s) or law, and violation(s) were documented on the violation notice issued to the facility. 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 (Willie Barnes), Licensing Inspector at (757) 439-6815 or by email at willie.barnes@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-1110-A
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure prior to admitting a resident with a serious cognitive impairment due to a primary psychiatric diagnosis of dementia to a safe, secure environment (scu), the licensee, administrator, or designee shall determine whether placement in the special care unit is appropriate. The determination and justification for the decision shall be in writing and shall be retained in the resident?s file. Evidence: 1. On 4-16-24, resident #1?s record noted resident was admitted to the safe, secure unit upon admission to the facility on 2-21-23. The resident?s record did not have documentation of the determination and justification for placement from the licensee, administrator, or designee. 2. Resident #2?s record noted resident was related to the safe, secure unit 1-9-24. The resident?s record did not have documentation of the determination and justification for placement from the licensee, administrator, or designee. 3. Staff #1 and #2 acknowledged the residents? record did not have documentation of the facility?s justification and determination for placement in the safe, secure and unit.
Plan of Correction:	1. Resident #1 and Resident #2 Determination and Approval for Placement for them to be admitted to a secured unit was signed by the administrator on admission of residents. The reasoning for the placement was corrected on 4/17/2024 by the Administrator. 2. The Nurse Educator/designee will audit all memory care resident records to Ensure that the administrator has given reason as to why the resident is being place on memory care. 3. The Administrator/Designee Will educate the clinical leaders on ensuring residents admitted with serious cognitive impairment to a secure unit is appropriate and the justification is in writing in the EMR. 4. The Administrator/designee will audit 3 residents weekly for 8 weeks to ensure documents are present for those residents with cognitive impairment to a secure unit is appropriate and the justification is in writing on the EMR. The results of the audit will be reported to the QA Committee for analysis and recommendation. 5. All corrective actions will be completed by 6/30/2024.
Standard #:	22VAC40-73-220-A
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure the requirements of 22VAC40-73-250-D.1 through D.4 regarding tuberculosis (TB) are applied to private duty personnel and that the required reports are maintained by the facility or the licensed home care organization. Evidence: 1. On 4-25-24, resident #7?s chart noted resident receives private sitters/companion services. Staff #4 provided sitters/companion record. C-SVS-1 TB was dated 8-16-23. Services for the resident was started on 4-19-24. The record did not include documentation of orientation as required. 2. Staff #1 acknowledged the facility did not have a current TB and orientation was not documented prior to start of services.
Plan of Correction:	1. The private sitter/companion?s current TB was sent to facility on 4/17/2024 and placed in the employee record. of survey. Orientation was completed on 4/22/204 and 4/23/2024 and filed in the employee record. 2. Administrator/designee will complete an audit of all private duty sitters/companions to ensure all required documents including current TB and orientation are present. 3. Administrator/designee will provide annual education to all clinical leaders on the requirements for private duty sitters/companions including orientation and TB requirements. 4. Administrator/designee will audit all new files for private duty sitters /companions weekly for 8 weeks using a checkoff list to ensure all required information is present. The results of the audits will be reported at the QA Committee Meetings for analysis and recommendations. 5. All Corrective Actions will be completed by June 30, 2024.
Standard #:	22VAC40-73-260-C
Description:	Based on observation and staff interviewed, the facility failed to ensure a listing of all staff who have current certification in first aid or CPR was posted in the facility so that the information was readily available to all staff at all times. Evidence: 1. On 4-16-24 during a tour of the facility with staff #9 and #10, the inspector inquired where the first aid/CPR listing was posted in the facility. Staff members did not know where the document was posted. Staff #1 also searched for the document on Keswick-2B and did not locate the document. A document was located but it was not current and expiration dates were 2021 and 2022 and March 2023. 2. On 4-16-24, staff #1 acknowledged the first aid/CPR listing of all staff with current certification was not available and posted.
Plan of Correction:	1. On 4/17/2024 the listing of all staff with current certification in first aid and CPR was posted on day of inspection. 2. Unit Manager will post updated list monthly to ensure that list is up-to-date and accurate. 3. Administrator/Designee will educate the Nurse Managers on the requirement of ensuring a list of all staff who have current certification in First Aid/CPR is posted in the facility daily. 4. The Administrator/designee will audit to three units weekly for 8 weeks to ensure the staff listing is current and accurate to include First Aid/CPR. The results of the audits will be reported to the QA meeting for analysis and trends. 5. All corrective actions will be completed by 6/30/2024.
Standard #:	22VAC40-73-450-C
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure the individualized service plan included all assessed needs. Evidence: 1. On 4-16-24, resident #4?s uniformed assessment instrument (UAI) dated 1-8-24 noted bathing assessed as mechanical help/human help/supervision (mh/hh/s). The ISP dated 1-11-24 did not include the type of mechanical device needed and who will provide services. Dressing assessed as no help needed; the ISP noted human help but did not specify who will provide services. Eating/feeding assessed as no help needed; the resident?s diet order dated 1-5-24 noted ?chopped meats?. This was not on the ISP. Walking assessed as mh; mechanical device not noted on the ISP, resident observed using a rollator walker. Orientation assessed as some spheres all time (place), stairclimbing and mobility assessed as mh; these needs were not noted on the ISP. Housekeeping need did not include who and when services will be provided. 2. Staff #1 acknowledged the resident?s ISP did not include all assessed needs and all elements of the ISP.
Plan of Correction:	1. Resident #4 ISP and UAI were updated to include all assessed needs and services on 4/19/2024 by nurse manager. 2. Unit Managers/designees will review 100% of resident records to validate UAIs and ISPs include all assessed needs. 3. The Administrator /designee will provide education to the certified clinical staff on ensuring the ISP includes all assessed needs. 4. The Administrator/Designee will audit ten UAIs and ISPs monthly for 6 months to ensure all needs are documented on the UAI/ISP. The results of the audits will be reported to QA Committee for analysis and recommendations. 5. All corrective actions will be completed by 11/30/2024.
Standard #:	22VAC40-73-450-E
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure the individualized service plan (ISP) was signed and dated by the licensee, administrator, or designee (i.e. the person who has developed the plan), and by the resident or resident?s legal representative? These requirements shall also apply to reviews and updates of the plan. Evidence: 1. On 4-16-24 residents #1?s ISP revised 8-16-23, resident #2?s ISP revised 11-21-23, resident #3?s ISP revised 1-4-24, resident #4?s ISP developed 1-11-24 and resident #5?s ISP revised 1-4-24 were not signed and dated by the resident, legal representative, and facility staff. 2. On 4-25-24 resident #7?s ISP revised 9-23-23 did not include the signature of the resident, legal representative, and facility staff. 3. Staff #1, #2 and #3 acknowledged the residents? ISP did not include required signatures.
Plan of Correction:	1. Residents #1, #2, #3, #4, #5, #7?s ISPs were all signed by the developer(Nurse Manager) and care conferences were held to ensure signatures from resident and/or legal representative were obtained on 4/30/2024. 2. The Nurse Managers and/or designee will audit all ISPs to ensure that the developer, resident/legal guardian have signed and dated. 3. The Administrator/designee will educate the unit managers on ensuring the ISP is signed and dated by the licensee/administrator/ designee and by the resident or legal representative upon reviews and updates to the plan. Unit Manager and/or designee will conduct and audit of 100% of all ISPs to ensure signatures have been obtained. 4. The Administrator/designee will audit 3 ISPs weekly for 8 weeks to ensure all ISPs have been signed per regulatory guidelines. The results of the audits will be reported to QA Committee for analysis and recommendation. 5. All corrective actions will be completed by 6/30/2024.
Standard #:	22VAC40-73-450-F
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure the individualized service plan (ISP) included all resident?s assessed needs. Evidence: 1. Resident #1?s uniformed assessment instrument (UAI) dated 3-13-24, noted bathing need assessed as mechanical help/human help/supervision (mh/hh/s). The ISP revised on 8-16-23 did not identify who will provide services. Dressing assessed as no help. The ISP noted does need help. The plan did not who, when, where or what services were to be provided. Resident assessed as disoriented some spheres, some of the time (place and time). The ISP did not include this assessed need. 2. Resident #2?s UAI dated 1-9-24, noted bathing need assessed as mh/hh/s; the ISP revised on 11-21-23 bathing, ?does not need help?. Stairclimbing assessed as mh and orientation assessed as disoriented some time to time, these needs were not on the ISP. Housekeeping and laundry noted as help needed, the ISP did not note who, what and where services will be provided. 3. Resident #3?s UAI dated 2-9-24 noted stairclimbing assessed as mechanical help (mh); need not noted on 1-4-24 revised ISP. Code status, money management and housekeeping did not include who, when and where services will be provided. 4. Resident #5?s UAI dated 9-20-23 noted bathing assessed as mh/hh/s; the ISP revised on 1-4-24 did not include who will provide services. Transferring assessed as mh; the ISP noted ?does not need help?. Stairclimbing assessed as mh; this need not on the ISP. Housekeeping did not include who, when and what services will be provided. Physical and occupational therapy services were initiated October 2023 and discharge from services was 12-11-23. These services were not documented on the resident?s ISP. 5. Resident #6?s UAI dated 1-24-24 noted bathing assessed as mh/hh/pa; the ISP revised 7-19-23 noted hh and did not include who will provide services and when. Dressing assessed as mh/hh/s; the ISP noted ?human physical help? and did not include who will provide services and when. Toileting assessed as mh; the ISP did not include what mechanical device was needed. Transferring assessed as no help; the ISP noted ?needs mechanical help transferring in and out of bed, shower, and toilet. Rounding four times a shift, Code Status (DNR), housekeeping did not include who will provide services. Laundry noted as assistance needed; not noted on the ISP. 6. Resident #7?s UAI dated 5-24-23 noted bathing assessed as mh; the revised ISP dated 9-12-23 and 1-4-24 did not include what mechanical device was needed. Stairclimbing assessed as mh; this need is not noted on the ISP. The resident?s behavior assessed as appropriate, the resident has been aggressive with others and recently have companion services to assist with behaviors. 7. Staff #1 and #2 acknowledged the residents ISP did not include all assessed needs and elements of the ISP.
Plan of Correction:	1. Residents #1, #2, #3, #5, #6, #7?s UAIs and ISPs will be updated to reflect the resident?s assessed needs on 5/2/2024 by a Nurse Manager. 2. Nurse Managers and/or designee will audit of 100% of UAI/ ISPs to ensure that the residents needs are being documented appropriately. 3. The Administrator/designee will educate the Nurse Managers on ensuring the ISP includes all the residents? assessed needs and that the notices will be sent to Responsible Party notifying them of the date and time for care conferences. Unit Manager and/or designee will conduct and audit of 100% of all ISPs to ensure signatures have been obtained. 4. The Administrator/designee will audit 3 ISPs weekly for 8 weeks to ensure that all ISPs include the assessed needs of the resident and signatures are present. The results of the audit will be reported to the QA Committee for analysis and recommendation. 5. All corrective actions will be completed by 6/30/2024.
Standard #:	22VAC40-73-680-C
Description:	Based on observations, record reviewed, and staff interviewed, the facility failed to ensure medications was be administered not earlier than one hour before and not later than one hour after the facility?s standard dosing schedule. Evidence: 1. On 4-16-24, medication pass observation was conducted with staff #8. Resident #5?s April 2020 medication administration record (MAR) noted Hyoscyamine Sulfate to .be administered before meals, time noted 07:30, 11:30 and 1630. The Omeprazole capsule to be administered at 08:00. These medications were administered at approximately 09:15. Staff stated the resident slept late. 2. Staff #1 acknowledged the medications should be administered within the timeframe.
Plan of Correction:	1. Resident #5?s had no adverse outcome from medication administration outside of time frame. The Nurse Manager obtained an order to request time change for the medication on 4/20/2024. 2. The Nurse Managers will audit residents who like to sleep late to ensure medication administration times are appropriate. 3. The Administrator/Designee will educate all clinical staff on notification to the provider if medication times need to be adjusted. 4. The Nurse Managers/designee will audit 4 residents who are scheduled to take medications with meals to ensure all times are appropriate per residents? request/schedule. The results of the audit will be reported. to the QA Committee for analysis and recommendation. 5. All corrective actions will be completed by 6/30/2024.
Standard #:	22VAC40-73-690-G
Description:	Based on documents reviewed and staff interviewed, the facility failed to ensure it took action in response to the recommendations noted in the pharmacy review and documented the information in the resident?s record for one of three reviews. Evidence: 1. On 4-25-24, a review of the January 2024 pharmacy review recommended, resident #3?s Celexa 40mg daily dose be lower to 20mg daily. The maximum dose is 20mg daily for patients greater than 60 years of age due to the risk of QT prolongation. Staff #2 stated the document had not been sent to the resident?s physician for a response. 2. Staff #1 and #2 acknowledged the facility did not take action in response to the pharmacy review?s recommendation.
Plan of Correction:	1 Resident #3 pharmacy review recommendation was sent to physician on 4/17/2024 and no changes were made. 2 The Nurse Managers/designee will audit all within the last six months have been responded to by physician and documented in the resident records. 3 The Administrator and Nurse Educator will conduct a training on pharmacy reviews and the requirements per state regulations. 4 The Administrator/designee will conduct an audit of 15 pharmacy reviews monthly for eight weeks to ensure follow up is completed. The results of the audit well be reported to the QA Committee for analysis and recommendation. 5 All corrective actions will be completed by 6/30/2024
Standard #:	22VAC40-73-960-B
Description:	Based on observations and staff interviewed the facility failed to ensure a fire and emergency evacuation drawing was posted in a conspicuous place on each floor of each building used by residents. Evidence: 1. On 4-16-24 a tour of the facility?s first floor from Evergreen to the gym area was conducted with staff #1 and #14. The assisted living unit from the area outside Evergreen to the gym area and to the main entrance area, there was no evacuation plan drawing posted. 2. Staff #1 and #14 acknowledged the first floor area toured did not have a posted fire and emergency evacuation drawing.
Plan of Correction:	1. The fire and emergency evacuation drawing were posted on 4/17/2024 by the Administrator. 2. An audit was conducted by the facilities director on all units to ensure emergency evacuation plan was posted. 3. The Administrator/designee will educate the maintenance staff on ensuring a fire and emergency evacuation drawing is posted on each unit and to verify when all renovations are completed. 4. The Facilities Directors and/or designee will audit each unit weekly for 8 weeks to ensure the fire and emergency evacuation drawing is posted on each unit. The results of the audits will be reported to the QA Committee for analysis and recommendation. 5. All corrective actions will be completed by 6/30/2024.
Standard #:	22VAC40-73-960-C
Description:	Based on observations and staff interviewed the facility failed to ensure the telephone numbers for the fire department, rescue squad or ambulance, police, and Poison Control Center shall be posted by each telephone shown on the fire and emergency evacuation plan. Evidence: 1. On 4-16-24, during a tour of the facility, the Poison Control Center number was not posted in the nurse?s station on the second floor, Keswick (2 B). Staff #1 searched but was not able to locate the information. 2. Staff #1 acknowledged the Poison Control Center number was not posted as required.
Plan of Correction:	1. The telephone numbers for the fire department, rescue squad or ambulance, police and Poison Control Center were immediately posted on 4/17/2024 by the Administrator. 2. An audit Conducted by the Administrator/designee to ensure the emergency telephone numbers were posted by the telephone shown on the fire and evacuation plan. 3. The Administrator/ designee will educate the clinical staff of checking daily to ensure emergency numbers are posted by the telephone shown on the fire and evacuation plan. 4. The Administrator/designee will conduct each unit weekly for 8weeks to ensure the emergency telephone numbers are posted by the telephone shown on the fire and evacuation plan. The results of the audits will be reported to the QA Committee for analysis and recommendation. 5. All corrective actions will be completed by 6/30/2024.