VIRGINIA DEPARTMENT OF SOCIAL SERVICES

White Birch Communities
847 Oakwood Drive
Rockingham, VA 22801-3924
(540) 879-9699

Current Inspector: Jessica Gale (540) 571-0358

Inspection Date: Aug. 26, 2020 and Aug. 27, 2020

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 ACCOMODATIONS AND RELATED PROVISIONS 22VAC40-73 BUILDING AND GROUNDS 22VAC40-73 EMERGENCY PREPAREDNESS 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS Article 1 Subjectivity 63.2 General Provisions. 63.2 Protection of adults and reporting. 63.2 Facilities and Programs.. 22VAC40-90 Background Checks for Assisted Living Facilities 22VAC40-90 The Sworn Statement or Affirmation 22VAC40-90 The Criminal History Record Report

Technical Assistance:

Areas of the standards reviewed due to questions: 1) Ensure when multiple medications are ordered for the same thing, the order reflects the specific symptoms for when each medication is to be given so staff will know what to give when. 2) The instructions of what to do if symptoms persist for as needed (PRN) medications need to be on each order/medication administration record only for those residents who are incapable of determining when the medication is needed. 3) Having a fire drill during a staff meeting to cover two shifts is fine as long as it is an additional drill and per standard 970.A and B. 4) On the fire drill form recommend using the term "corrective action taken" rather than the word "outcome" to ensure clarity for staff. 5) If a resident is admitted with a dermal ulcer/wound it still needs to be reported even though it did not develop while in the facility. 6) Reviewed the required generator information and standards that become effective in December 2020 (950 and 980).. 7) Send health inspection report to this inspector upon receipt. 8) When posting multiple activity calendars, ensure the same activity calendar is posted in all areas of the assisted living unit. 9) When hospice issues an order to titrate oxygen as needed, the order needs to indicate that only a nurse can titrate. 10) Staff B is due a tuberculin screening/test this month.

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 8/25/20 and concluded on 8/27/20. The administrator was contacted by telephone to initiate the inspection. The administrator reported that the current census was 51 (which included 14 in the secured unit and 37 in the assisted living unit). The inspector emailed the administrator a list of items required to complete the inspection. The inspector reviewed four resident and four staff records. Selected sections of one additional staff and one contract staff were also reviewed. A virtual tour was conducted as well as a review of the posted menu, activities calendar, staff first aid and cardiopulmonary resuscitation certification list, violation notice and residents' rights. The previous violations were reviewed as was resident personal account information. Additional information was requested in various areas of the standards and was submitted as requested by the administrator and reviewed by this inspector. Information gathered during this inspection determined non-compliance in the areas of individualized service plans and medication administration records and violations were documented on the violation notice issued to the facility..

Violations:

Standard #:	22VAC40-73-680-K
Description:	Based upon documentation and an interview, the facility failed to ensure two of the four residents physicians' orders reviewed included all of the required information. Evidence: 1) Resident B had signed physician's orders for acetaminophen, acetaminophen suppositories and oxycodone, and all had a diagnosis for pain; bisacodyl and senna lax both had a diagnosis for constipation. 2) Resident C had signed physician's orders for acetaminophen suppositories, oxycodone and morphine sulfate, and all had a diagnosis for pain; haloperidol and ondansetron both had a diagnosis for nausea. 3) There were no symptoms listed on any of these orders listed above which would indicate which medication to give for what symptoms. 4) On 8/27/20, the licensing inspector (LI) interviewed the administrator and director of nursing (DON) and both stated the orders did not indicate the symptoms that would indicate which medication to give..
Plan of Correction:	After reviewing the physicians' orders for residents B and C, a plan was made by the administrator, DON, and the director of resident services (DRS), to obtain orders to be specifically spelled out for hospice residents to include only one indication for each as needed (PRN) medication. If two different routes are available for the same medication, then orders will be clarified stating that if a resident is unable to swallow a pill, then the rectal form shall be used. The DON will meet with all hospice nurses to obtain the corrected orders for each resident. The DON and DRS will work in conjunction with the house nurse practitioner and hospice nurses to ensure that future orders are in compliance with this standard. The administrator will conduct random reviews monthly to ensure compliance with his standard.
Standard #:	22VAC40-73-930-D
Description:	Based upon interviews and documentation, the facility failed to ensure two of the four individualized service plans (ISPs) reviewed included all required information. Evidence: 1) The ISPs (completed 8/25/20) for residents A and B, indicated the residents were unable to use their call bells; however, they did not indicate the minimal frequency of daily rounds to monitor for emergencies or needs. 2) On 8/26/20, the LI interviewed the administrator and DON and both stated this information was not included on the ISPs.
Plan of Correction:	After reviewing the current ISPs for residents A and B, the missing information regarding the minimal frequency of daily rounds to monitor for emergency needs was added by the DON. All other memory care residents' ISPs have been updated with this information. The DON will ensure all future ISPs indicate the frequency of rounding for residents who are physically or mentally unable to ring a call bell. The administrator will conduct random reviews of ISPs to ensure compliance with this standard.