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: May 14, 2024

Complaint Related: No

Areas Reviewed:

22VAC40-73 RESIDENT CARE AND RELATED SERVICES Type of inspection: Monitoring Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 05/14/2024 ( arrival 11:41am/ departure 2:19pm) The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. A self-reported incident was received by VDSS Division of Licensing on 05/02/2024 regarding allegations in the area(s) of: Resident Care and Related Services Number of residents present at the facility at the beginning of the inspection: 31 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 2 Number of interviews conducted with residents: 1 Number of interviews conducted with staff: 1 Observations by licensing inspector: Additional Comments/Discussion: An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation supported some, but not all of the self-report; area(s) of non-compliance with standard(s) or law were: Resident Care and Related Services A violation notice was issued; any violation(s) not related to the self-report but identified during the course of the investigation can also be found on the violation notice. 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 Darunda Flint, Licensing Inspector at (757) 807-9731 or by email at Darunda.a.flint@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-450-C
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure the comprehensive individualized service plan (ISP) was completed within 30 days after admission and included all required assessed needs. Evidence: 1. Resident #1?s uniformed assessment instrument (UAI) dated 12/5/2023 documented stairclimbing as mechanical help. The ISP dated 12/23/2023 did not document the type of mechanical help. The resident has a Do Not Resuscitate Order (DNR). The DNR order is not documented on the ISP. The resident?s date of admission was documented as 12/13/2023. 2. Staff #1 acknowledged the ISP did not include the assessed needs of the aforementioned resident.
Plan of Correction:	1. Resident #1s ISP was updated by the AL Director on 5/15/2024 to reflect type of mechanical help needed and DNR status 2. All ISPs will be reviewed by AL Director/Designee to ensure needs identified on the UAI are reflected on the ISP. 3. Assistant Chief Nursing Officer will educate AL Director on ensuring ISP is reviewed and updated at least once every twelve months, and as needed, for significant change of a resident?s condition and includes all assessed needs. 4. AL Director/Designee will audit two UAIs/ISPs weekly for accuracy and compliance for eight weeks. The results of the audit will be reported at the QA meeting for evaluation and compliance. 5. All corrective actions will be completed by 9/30/24
Standard #:	22VAC40-73-450-F
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure the individualized service plan (ISP) was reviewed and updated at least once every 12 months and as needed for a significant change of a resident?s condition and include assessed needs. Evidence: 1. Resident #2?s UAI dated 8/7/2023 documented bathing as mechanical and human help. The ISP dated 9/14/2023 documented mechanical help. Resident?s date of admission documented as 3/15/2022. 2. Staff #1 acknowledged the ISP did not include the assessed needs of the aforementioned resident.
Plan of Correction:	1. Resident #2s ISP dated 9/14/23 was updated by the AL Director on 5/15/2024 to include mechanical and human help. 2. All ISPs will be reviewed by AL Director/Designee to ensure needs identified on the UAI are reflected on the ISP. 3. Assistant Chief Nursing Officer will educate AL Director on ensuring ISP is reviewed and updated at least once every twelve months, and as needed, for significant change of a resident?s condition and includes all assessed needs. 4. AL Director/Designee will audit two UAIs/ISPs weekly for accuracy and compliance for eight weeks. The results of the audit will be reported at the QA meeting for evaluation and compliance. 5. All corrective actions will be completed by 9/30/24
Standard #:	22VAC40-73-650-A
Description:	Based on record review and discussion, the facility failed to ensure no medication, dietary supplement, diet, medical procedure, or treatment be started, changed, or discontinued by the facility without a valid order from a physician or other prescriber. Medications include prescription, over the counter, and sample medications. Evidence: 1. The 5/01/2024 progress notes for Resident #1 documented a medication error in which the resident was given Metoprolol, and this medication is listed as an allergy for resident #1. 2. Staff #1 documented on 5/01/2024 that the resident was given the wrong medication at morning med pass.
Plan of Correction:	1. Resident #1 did not have an adverse outcome from medication received on 5/1/24 2. All residents on 5/1/23 received their appropriate medications without incident. 3. AL Director/Designee will educate the clinical staff on the 10 Rights of Medication Administration. 4. AL Director/Designee will audit one nurse weekly to ensure proper medication administration for eight weeks. The results of the audit will be reported at the QA meeting for evaluation and compliance. 5. All corrective actions will be completed by 9/30/24