VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Hawksbill Assisted Living
122 N Hawksbill Street
Luray, VA 22835
(540) 743-6229

Current Inspector: Sarah Pearson (540) 680-9469

Inspection Date: Sept. 29, 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 32.1 REPORTED BY PERSONS OTHER THAN PHYSICIANS 63.2 GENERAL PROVISIONS 63.2 PROTECTION OF ADULTS AND REPORTING 22VAC40-90 BACKGROUND CHECKS FOR ASSISTED LIVING FACILITIES 22VAC40-90 THE SWORN STATEMENT OR AFFIRMATION 22VAC40-90 THE CRIMINAL HISTORY RECORD REPORT

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: Two licensing inspectors from approximately 9:58am until 11:45am Number of residents present at the facility at the beginning of the inspection: 39 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 9 Number of staff records reviewed: 4 Number of interviews conducted with residents: 2 Number of interviews conducted with staff: 2 An exit meeting will be conducted to review the inspection findings. The 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 Rhonda Whitmer, Licensing Inspector at (540)292-5932 or by email at rhonda.whitmer@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-620-A
Description:	Based on document review and an interview, the facility failed to ensure that on oversight of special diets by a dietician or nutritionist was completed at least every six months. EVIDENCE: 1. The dietary oversight on file is dated 11/20/2021. 2. An interview with the administrator on 09/29/2022 confirmed that an oversight of special diets had not been completed since 11/20/2021.
Plan of Correction:	The Licensee will seek out and hire a Dietician/Nutritionist to work with the Administrator to monitor diets and weights.
Standard #:	22VAC40-73-680-D
Description:	Based on review of residents? records and interviews, the facility failed to ensure medications are administered in accordance with the physician?s instructions. EVIDENCE: 1. Resident 7 has the following order: Amlodip-Benaz 10-40mg capsule-Take one capsule by mouth daily. 2. The September MAR for resident 7 indicates medication was not administered on 09/15/2022 through 09/28/2022. Documentation indicates ?medication unavailable, med unavailable sheet completed? 3. The LI interviewed the administrator who confirmed resident 7 did not receive the medication from 09/15/2022 through 09/28/2022 and physician was not notified. 4. Resident 5 has the following order effective from 03/08/2021 through 09/07/2022: Blood Glucose Testing-Check blood sugar two times daily, call MD if less than 70 or greater than 350. 5. Documentation in the September MAR indicates resident 5?s blood glucose was 398 on 09/01/2022 at 8:00am. There is no documentation of physician notification. 6. Resident 5 has the following order: Novolog 100U/ML-Inject subcutaneously three times a day per sliding scale- 200-250 4 Units; 251-300 6 Units; 301-350 8 Units; 351-400 10 Units; Call NP if less than 80 or greater than 400. 7. Documentation in the September MAR indicates resident 5?s blood glucose was 408 on 09/17/2022 at 5:00pm; 408 on 09/22/2022 at 5:00pm and 422 on 09/23/2022 at 5:00pm 8. The LI interviewed the staff 3 who confirmed physician was not notified of resident?s blood glucose of 408 on 09/17/2022 at 5:00pm; 408 on 09/22/2022 at 5:00pm and 422 on 09/23/2022 at 5:00pm.
Plan of Correction:	Med techs were reminded to always notify the Administrator and physician when medications are not at the facility. Med techs were reminded to always notify physician when diabetic ranges are out of range. Medication training was done with all med techs on diabetic treatments.