VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Riverside Assisted Living at Sanders
7407 Walker Avenue
Gloucester, VA 23061
(757) 693-2000

Current Inspector: Darunda Flint (757) 807-9731

Inspection Date: Dec. 8, 2020 , Dec. 9, 2020 , Dec. 16, 2020 and Dec. 18, 2020

Complaint Related: No

Areas Reviewed:

22VAC40-73 PERSONNEL 22VAC40-73 STAFFING AND SUPERVISION 22VAC40-73 ADMISSION, RETENTION, AND DISCHARGE OF RESIDENTS 22VAC40-73 RESIDENT CARE AND RELATED SERVICES 63.2 Protection of adults and reporting. 22VAC40-90 The Sworn Statement or Affirmation 22VAC40-90 The Criminal History Record Report

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 renewal inspection was initiated on 12-8-20 and concluded on 12-18-20. The administrator was contacted by telephone to initiate the inspection. The administrator reported that the census was 30. The inspector emailed the administrator a list of items required to complete the inspection. The inspector reviewed 3 resident records, 3 staff records, staff schedules, emergency drills, fire and health inspections, submitted by the facility to ensure documentation was complete. Information gathered during the inspection determined non-compliances with applicable standards or law, and violations were documented on the violation notice issued to the facility.

Violations:

Standard #:	22VAC40-73-210-F
Description:	Based on record review and staff interview, the facility failed to ensure when adults with mental impairments reside in the facility, at least four of the required hours shall focus on topics related to residents? mental impairment for one of three staff record reviewed. Evidence: 1. During the remote renewal inspection on 12-09-20, a review of staff #4?s transcript of training hours submitted did not include the required annual four hours of training focusing on topics related to mental impairments. Staff?s date of hire noted as 01-21-20. 2. Staff #1 and #2 acknowledged staff?s training transcript submitted did not include required four hours of mental health training.
Plan of Correction:	1.The clinical educator has assigned 4 hours of necessary mental impairment training to staff member #4. Staff member #4 will complete by January 20, 2021 2.Clinical educator or designee will audit staff records for necessary 4 hours of mental impairment training and will assign as needed. 3.All campus staff that could be scheduled to work in ALF will be assigned required 4 hours mental impairment training annually by clinical educator or designee. 4.Assisted Living Director or designee will audit two staff member transcripts monthly for 3 months to ensure training is assigned and completed. Results will be reported at QAPI for tracking and trending. 5.February 12, 2021
Standard #:	22VAC40-73-260-A
Description:	Based on record review and staff interview, the facility failed to ensure direct care staff who does not have current certification in first aid as specified in regulation shall receive certification in first aid within 60 days of employment for two of three staff. Evidence: 1.During the remote renewal inspection on 12-9-20, a review of documents submitted for review for staff #4?s record, did not include documentation of first aid when staff worked as a direct care staff in the assisted living unit. According to staff #2, staff was initially hired as a certified nurse?s aide on 1-20-20, became a licensed practical nurse in July 2020. Staff?s date of hire 1-20-20 adjusted to reflect full time status on 7-21-20 in assisted living. 2. A review of staff #5's record did not include documentation of first aid within 60 days of hire. Staff date of employment in assisted living noted as 7-21-20.
Plan of Correction:	1.Staff member #4 is now a nurse and no longer is required to have first aid training. Staff member #5 was given first aid training on December 14, 2020. Due to COVID 19 restrictions and American Heart Association guidelines she was not able to be trained with 60 days of transferring to Assisted Living. 2.Clinical Educator or designee will review education and certification records for all direct care staff that might work in Assisted Living Facility. First Aid training will be provided to all direct care staff that are not currently certified in First Aid. 3.All direct care new hires will receive first aid training within 60 days of hire. 4.Assisted Living Director or designee will conduct an audit of all newly hired direct care staff to ensure that all staff are certified in first aid within 60 days of hire. Results will be reported at QAPI for tracking and trending. 5.February 12, 2021
Standard #:	22VAC40-73-450-C
Description:	Based on record review and staff interview, the facility failed to ensure the individualized service plan (ISP) included all assessed needs for three of three records. Evidence: 1. During remote renewal inspection 12-9-20, a review of resident #1?s November 2020?s medication administration record (mar) noted allergy to Codeine. Also a review of resident?s progress notes from physician?s visit signed and dated 1-8-20 noted resident?s allergy to Codeine. This information was not noted on the resident?s individualized service plan (ISP) dated 9-4-20. 2. A review of resident #2?s medication administration record (mar) for November 2020 noted resident, ?may self-administer? Caldyhen Lotion and ?may self- administer and keep at bedside? the following: Calcium Carbonate, Lac-Hydrin lotion, and Nystatin Cream. This information is also noted on the resident?s October 2020 and December 2020 physician?s order sheet (pos). A review of resident #2?s admitting physical examination dated 3-12-20, the self-administration question is checked, yes. However, the uniformed assessment instrument (uai) dated 4-1-20 and individualized service plan (ISP) noted medication administered and monitored by facility staff. The individualized service plan did not include the resident?s medication that is kept at bedside and resident self-administration of medications. 3. A review of resident #3?s medication administration record (mar) for November 2020 noted Voltaren scheduled and as needed noted ?may keep at bedside, may self-administer?. Resident #3?s physical examination dated 12-12-19 was checked yes for self-administration. However, the uai dated 4-7-20 and ISP dated 4-7-20 noted medication administered and monitored by facility staff. The individualized service plan did not include the resident?s medication that is kept at bedside and resident self-administration of medications.
Plan of Correction:	1.ISP for resident #1 was updated to include allergy to codeine. ISP and UAI for resident #2 was updated to include may self-administer medications as ordered by physician and requires some assistance with medication administration. ISP and UAI for resident #3 was updated to include may self-administer medications as ordered by physician and requires some assistance with medication administration. 2.All resident MARS and POS will be reviewed for physician orders to self-administer medication. ISPs and UAIs will be reviewed for accuracy and updated accordingly. 3.Assisted Living Director or designee will audit new medication orders weekly for 5 weeks to insure orders for self-administration are on the ISP and UAI as appropriate. 4.Facility Administrator or designee will audit 5 resident charts monthly for ISP and UAI agreeance with self-medication orders. Results will be reported at QAPI for tracking and trending. 5.February 12, 2021.
Standard #:	22VAC40-73-650-B
Description:	Based on record review and staff interview, the facility failed to ensure the physician or other prescriber orders, both written and oral, for administration of all prescription and over-the-counter medications and dietary supplements shall identify the diagnosis, condition, or specific indications for administering the drug for one of three residents. Evidence: 1.During the remote renewal inspection, a review of resident #1?s physician?s orders dated 1-8-20 did not include diagnosis for the following: Bumeteride, Digoxin, Simvastatin, Vitamin C, Lomotil, Omeprazole and Meclizine. Physician order dated 11-24-20 did not include diagnosis for Lomotil (M-W-F). Physician order dated 6-30-20 did not include diagnosis for Ferrous Sulfate.
Plan of Correction:	1.Resident #1?s physician was contacted by facility nurse to clarify the diagnosis for Bumeteride, Digoxin, Simvastatin, Vitamin C, Lomotil, Omeprazole and Meclizine, and Ferrous Sulfate. Signed orders with diagnosis were added the Resident #1?s clinical record and MAR. 2.Assisted Living Director or designee will conduct an audit of all residents? medications for diagnosis. 3.Licensed staff will be educated by the clinical educator or designee on the transcription of medication orders to include all required content including diagnosis or indications for use. Assisted Living Director or designee will audit all new orders weekly for 4 weeks to ensure medication orders contain diagnosis or indications for use. 4.Results will be presented at QAPI for tracking and trending. 5.February 12, 2021.
Standard #:	22VAC40-73-680-K
Description:	Based on record review and staff interview, the facility failed to ensure when medication aides administer PRN (as needed) medication, the prescriber's detailed order include the exact dosages, the exact timeframes the medication is to be given in a 24-hour period, and directions as to what to do if symptoms persist for one of three records. Evidence: 1.During the remote renewal inspection, a review of resident #1?s November 2020 medication administration record (mar) noted Amlactin, apply ?1-2 applications all over as needed?, physician order dated 10-15-20. The facility employ medications aides to administer medications, and the prescriber?s order did not include the exact dosage.
Plan of Correction:	1.Resident #1?s physician was contacted by facility nurse to clarify the orders for the PRN medication Amlactin. Clarified orders were added to residents MAR and resident medical record. 2.Assisted Living Director or designee will conduct an audit of all residents? PRN medications for accuracy and exact dosing instructions. 3.Licensed staff will be educated by the clinical educator or designee on the transcription of medication orders including required content for routine and PRN medication to include exact dosages, exact timeframes the medication is to be given in a 24-hour period and directions on actions to take if symptoms persist. 4.Assisted Living Director or designee will audit all new medication orders contain all required information weekly for 4 weeks. Results will be presented at QAPI for tracking and trending. 5.February 12, 2021.
Standard #:	22VAC40-73-700-1
Description:	Based on record review and staff interview, the facility failed to ensure when oxygen therapy is provided, the facility shall have a valid physician?s orders or other prescriber?s order that included all required information for one of three residents. Evidence: 1.During remote renewal inspection, a review of resident #1?s November 2020 medication administration record (mar), noted resident was administered oxygen as needed, ?O2 @ 2L/minute via nasal cannula as needed?. Further review of the record did not include a prescriber?s order for the oxygen noted one resident #1?s mar. Staff #1 stated resident receives oxygen as needed.
Plan of Correction:	1.The prescriber for resident #1 was contacted by nursing staff to clarify the prescribing orders for oxygen therapy. 2.Assisted Living Director or designee will audit all clinical records ensure that all residents that receive oxygen therapy has a valid physician order that specifies use, liter flow and method of administration (nasal cannula, mask) for that therapy. 3.Licensed staff will be educated by clinical educator or designee to confirm resident has a signed clinical order that contains all required content for oxygen therapy prior to administering oxygen. 4.Assisted Living Director or designee will audit clinical records monthly for 3 months to ensure that all residents that receive oxygen therapy will have current prescriber orders, all required information and all required oxygen therapy information. Results will be reported at QAPI for tracking and trending. 5.February 12, 2021