VIRGINIA DEPARTMENT OF SOCIAL SERVICES

International Rejuvenation Center
221 West Main Street
Marion, VA 24354
(276) 782-1819

Current Inspector: Crystal Mullins (276) 608-1067

Inspection Date: Dec. 12, 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 ACCOMMODATIONS AND RELATED PROVISIONS 22VAC40-73 BUILDINGS AND GROUND 22VAC40-73 EMERGENCY PREPAREDNESS

Comments:

Type of inspection: Renewal Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 01/12/2022 Start 10:00am End: 1:43pm The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. Number of residents present at the facility at the beginning of the inspection: 9 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 3 Number of staff records reviewed: 3 Number of interviews conducted with residents: 2 Number of interviews conducted with staff: 2 Observations by licensing inspector: Additional Comments/Discussion: An exit meeting will be conducted to review the inspection findings. he 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 Crystal B. Henson Licensing Inspector at 276-608-1067 or by email at crystal.b.mullins@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-250-D
Description:	Based on a review of staff records, the facility failed to ensure a subsequent tuberculosis evaluation and report is complete. EVIDENCE: 1. The Report of TB Screening dated 10/21/2022 in the record for staff #3 is incomplete. The form is signed and dated by a physician but is otherwise incomplete as there are no items selected indicating staff tuberculosis status.
Plan of Correction:	Now completed properly. Administrator will monitor. [sic]
Standard #:	22VAC40-73-450-F
Description:	Based on a review of resident records, the facility failed to ensure individualized service plans are reviewed and updated at least once every 12 months and as needed for a significant change of a resident?s condition. EVIDENCE: 1. The most recent individualized service plan in the record for resident #5 is dated 02/04/2021. The date of inspection was 12/12/2022.
Plan of Correction:	ISP updated after records will be completed. Administrator will follow. [sic]
Standard #:	22VAC40-73-550-G
Description:	Based on a review of resident and staff records, the facility failed to ensure the rights and responsibilities of residents are reviewed annually with each resident or his legal representative or responsible individual and each staff person. EVIDENCE: 1. In the record for resident #5, no documentation was found indicating acknowledgement that the rights and responsibilities of the resident were reviewed within the past year. 2. In the record for staff #3, no documentation was found indicating acknowledgement that the rights and responsibilities of the residents were reviewed during the past year.
Plan of Correction:	Will correct going forward. Administrator will monitor. [sic[
Standard #:	22VAC40-73-640-A
Description:	Based on observations made during the medication cart audit, the facility failed to follow their medication management plan with regard to verifying that medication orders have been accurately transcribed to medication administration records (MARs) within 24 hours of receipt of a new order or change in an order. EVIDENCE: 1. An open box of 1% Silver Sulfadiazine Cream was found in the medication storage area for resident #4. The pharmacy label described the medication as SF 5000 Plus Cream, Fluoride (Sodium), use as directed once per day for dental health. The licensing inspector contacted the pharmacy and the pharmacist confirmed the label was correct, but it was placed in error on an incorrect medication by pharmacy staff.
Plan of Correction:	Will make sure meds are labeled correct. Administrator will follow. [sic]
Standard #:	22VAC40-73-680-D
Description:	Based on observations made during the medication cart audit, the facility failed to administer medications in accordance with the physician?s or other prescriber?s instructions and consistent with the standards of practice outlined in the current medication aide curriculum approved by the Virginia Board of Nursing. EVIDENCE: 1. Resident #6 is prescribed ClearLax Powder, mix 17 grams (1 capful) in 8 ounces water and drink for constipation. This medication did not contain an open date but had been opened and used. 2. Resident #6 is prescribed Fluticasone Propionate Nasal Spray USP 50 MCG, use 2 sprays in each nostril once daily for congestion. This medication did not contain an open date but had been opened and used. 3. Resident #7 is prescribed Travoprost Opthalmic Solution 0.004%, instill 1 drop into the left eye at bedtime for glaucoma. This medication did not contain an open date but had been opened and used. 4. Resident #7 is prescribed Restasis 0.05% Eye Emulsion, instill 1 drop into both eyes 2 times a day continuously for dry eye. This medication did not contain an open date but had been opened and used.
Plan of Correction:	Staff will write open dates on all meds Staff will follow regularly. [sic]
Standard #:	22VAC40-73-750-B
Description:	Based on observations made during the tour of the physical plant, the facility failed to ensure an operable bedside lamp or bedside light is accessible to each resident. EVIDENCE: 1. There was no operable bedside lamp or bedside light found in resident room number 102.
Plan of Correction:	The staff will make sure residents do not remove items. [sic]
Standard #:	22VAC40-73-750-E
Description:	Based on observations made during the tour of the physical plant, the facility failed to have sufficient bed and bath linens in good repair so that residents always have clean sheets. EVIDENCE: 1. There were no bed sheets found on the mattress in resident room number 102
Plan of Correction:	Staff will make sure residents do not remove items. [sic]
Standard #:	22VAC40-73-860-D
Description:	Based on observations made during the tour of the physical plant, the facility failed to ensure all operable windows (i.e., a window that may be opened) are effectively screened. EVIDENCE: 1. The windows in resident room number 102 and the dining area were not screened at time of inspection.
Plan of Correction:	Staff will make regular rounds to make sure residents do not remove items. [sic]
Standard #:	22VAC40-73-860-G
Description:	Based on observations made during the tour of the physical plant, the facility failed to ensure hot water at taps available to residents shall be maintained within a range of 105-120 degrees Fahrenheit. EVIDENCE: 1. The water in the first restroom on the left in the hallway, across from the desk, was found to be 123.6 degrees Fahrenheit on the date of inspection.
Plan of Correction:	Temp of water will be maintained. Handiman will monitor. [sic]
Standard #:	22VAC40-73-870-A
Description:	Based on observations made during the tour of the physical plant, the facility failed to ensure the interior and exterior of all buildings are maintained in good repair and kept clean and free of rubbish. EVIDENCE: 1. Coffee stains were observed on the top of the chest of drawers in resident room number 102. 2. Several areas of peeling paint were found in resident room number 102, along the back wall with the window, and the adjacent wall with the mirror. 3. Areas of what appeared to be loose dirt and dust were found on the floor in front of the closet in resident room number 102.
Plan of Correction:	Staff will clean regularly. Staff will follow [sic]
Standard #:	22VAC40-73-870-B
Description:	Based on observations made during the tour of the physical plant, the facility failed to ensure all buildings are well-ventilated and free from foul, stale, and musty odors. EVIDENCE: 1. A strong, foul odor was observed in resident room number 102.
Plan of Correction:	We will remind resident to be clean and bathe. Staff will make sure. [sic[