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. 6, 2021

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 ACCOMODATIONS AND RELATED PROVISIONS 22VAC40-73 BUILDING AND GROUNDS 22VAC40-73 EMERGENCY PREPAREDNESS 22VAC40-90 Background Checks for Assisted Living Facilities 22VAC40-90 The Sworn Statement or Affirmation 22VAC40-90 The Criminal History Record Report

Comments:

An unannounced renewal inspection was conducted on 12-6-21 (ar 08:15/ dep 3:15 p.m.) The facility census was 27. A tour of the facility was conducted, staff and resident records were reviewed, activity observed, medication pass observation was conducted, breakfast observed, resident and staff interviews conducted, call bell and water temperatures check, emergency supply checked, first aid kit checked for facility and transporting vehicle. rights. An exit meeting was conducted and the acknowledgement form was signed by the administrator. Please complete the columns for "description of action to be taken" and "date to be corrected" for each violation cited on the violation notice, and then return a signed and dated copy to the licensing office within 10 calendar days of receipt. You need to be specific with how the deficiencies either have been or will be corrected to bring you into compliance with the Standards. Your plan of correction must contain the following three points: 1. Steps to correct the noncompliance with the standard(s) 2. Measures to prevent the noncompliance from occurring again 3. Person(s) responsible for implementing each step and/or monitoring any preventive measure(s) Please provide your responses in a Word Document, if possible. POC due within 10 days: 12-18-21

Violations:

Standard #:	22VAC40-73-100-C-2
Description:	Based on observation and staff interviewed, the facility failed to ensure infection control procedures were implemented. Evidence: 1. On 12-7-21 during the medication observation check of the medication cart on the second floor with staff #5, resident #5?s and #6?s glucometer were not labeled. 2. During the exit meeting on 12-7-21, staff #1 acknowledged the glucometers for the aforementioned residents were not labeled.
Plan of Correction:	1). The Director of Assisted Living on 12/6/21 immediately labeled resident #5 and #6 glucometers wi1h their names. 2) All personal glucometers will be audited for appropriate name labels by the Administrator or designee. 3) Clinical staff will be re-educated by the Administrator or designee that all personal glucometers must be labeled with the resident's name and how to replace the name if needed. 4) The Administrator or designee will audit 50% of the personal glucometers for proper labeling of names weekly for 4 weeks and monthly for 3 months. Results of the audits will be reported monthly at COR/QAPI. 5) All corrective actions will be complete by January 5, 2022