VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Virginia Home for Adults
2701 Border Road
Chesapeake, VA 23325
(757) 545-6219

Current Inspector: Lanesha Allen (757) 715-1499

Inspection Date: Sept. 13, 2019

Complaint Related: No

Areas Reviewed:

22VAC40-73 ADMISSION, RETENTION, AND DISCHARGE OF RESIDENTS 22VAC40-73 RESIDENT CARE AND RELATED SERVICES

Comments:

This was an unannounced focused monitoring inspection, to follow-up on violations cited during a previous inspection and review the corrections submitted in response to the Intensive Plan of Correction (IPOC). The inspection was conducted on September 13, 2019 from 10:45 am until 1:17 pm. There were 49 residents in care. During the inspection, resident records were reviewed as well as the facility's emergency water supply. A check of the medication carts was conducted and a review of the new procedure for locking chemicals. A discussion was held regarding admission documentation to be reviewed for accuracy and completeness, also discussed emergency placement requests only to be made by a physician or Adult Protective Services. Please complete the "plan of correction" and "date to be corrected" for each violation on the violation notice. The plan of correction must indicate how the violation will be or has been corrected. It should include: 1. Step(s) to correct the non-compliance with the standard(s) 2. Methods to prevent re-occurrence, and 3. Person(s) responsible for implementing each step and/or monitoring any preventive actions.

Violations:

Standard #:	22VAC40-73-320-A
Description:	Based on record review and interview, the facility failed to ensure a resident obtained a physical examination by an independent physician containing the results of a risk assessment documenting the absence of tuberculosis (TB) in a communicable form, within 30 days prior to admission to the facility. Evidence: 1. During review of resident #2's record, the resident was admitted to the facility on 11-2-18. The resident had a physical examination dated 11-1-17 and a TB screening dated 11-4-17, one year prior to admission. The resident had another physical examination report in the record dated 12-12-18 and a TB screening also dated 12-12-18, 40 days after the resident's admission. 2. During interview, staff #1 acknowledged the facility did not have a physical examination on file completed within 30 days of the resident's admission.
Plan of Correction:	Our normal practice is to get all new forms at admission. Administrator and Office Manager will ensure all new admissions, physicals, TB tests, and all other necessary admission forms are completed within 30 days or less of new resident's admission. Going forth, the Office Manager and RMA manager will review all required forms prior to admission. Admission will only be excepted after dates are in compliance with 30 day standard, and triple checked by Administrator, Office Manager, and RMA Manager.
Standard #:	22VAC40-73-680-B
Description:	Based on record review, the facility failed to ensure medications remain in the pharmacy issued container, with the prescription label or direction label attached, until administered to the resident. Evidence: 1. During a check of the medication carts with staff #1 and staff #2, Licensing Inspector observed loose pills at the bottom of the drawer in the "Men and Women" medication cart, to include: 2 white round pills, 1/2 orange pill, 1 yellow pill, and 1 light blue pill. 2. Staff #1 and staff #2 acknowledged the loose pills in the cart.
Plan of Correction:	The Administrator met with all RMAs to discuss handling medication cards with care, and to reduce the chance of wasting medication. RMA manager has called the pharmacy to possibly use other types of pill containers, not easily pressed. Administrator and RMA Managers will check the cart daily and weekly, to ensure medications are not loose in the cart.