VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Lake Prince Woods
100 Anna Goode Way
Suffolk, VA 23434
(757) 923-5500

Current Inspector: Margaret T Pittman (757) 641-0984

Inspection Date: Dec. 13, 2019

Complaint Related: No

Areas Reviewed:

22VAC40-73 RESIDENT CARE AND RELATED SERVICES

Comments:

An unannounced focused monitoring inspection was conducted by the Licensing Inspector from the Eastern Regional Office on 12-13-2019 from 8:53 AM to 1:02 PM. There were 43 residents in care at the time of the inspection. A medication pass observation was conducted on the assisted living unit and 5 residents were observed during the medication pass. Physician's orders and Medication Administration Records were reviewed for the 5 residents observed. The facility's policies and procedures were also reviewed regarding the plan of corrections. The following was discussed with the Assisted Living Director: facility dosing schedule, physician's orders, PRN medications, and storage of medications. The facility received violations "under" Resident Care and Related Services. Areas of noncompliance were discussed with the Assisted Living Director throughout the inspection and during the exit interview. Please complete the ?plan of correction? for each violation cited on the violation notice and return it to me within 10 calendar days from today, 01-02-2020.

Violations:

Standard #:	22VAC40-73-680-C
Description:	Based on observation, record review, and interview, the facility failed to ensure medications are administered no earlier than one hour before and no later than one hour after the facility?s standard dosing schedule. Evidence: 1. During the morning medication pass observation, staff #2 was observed administering the following medications outside of the facility?s standard dosing schedule: A. At approximately 9:57 AM, resident #2 received Albuterol Sulfate 2.5 mg which was scheduled for 8:00 AM per the resident #2?s December 2019 Medication Administration Record (MAR). B. At approximately 10:30 AM, resident #3 received Lasix 40mg, Diltiazem 240mg, Eliquis 2.5mg, Calcium Carbonate 600mg, Fish Oil 360mg, Cinnamon 500mg, Duloxetine 60mg, Ferrous Sulfate 325mg, Tradjenta 5mg, Glucophage 500mg, Ferrous Sulfate 325mg, Pot Chloride 20meq, Red yeast rice powder, Therapeutic M, Areds 100 units, Artificial tears 1.4%, and Miralax 17gm. These medications were scheduled for 9:00 AM per resident #3?s December 2019 MAR. C. At approximately 10:50 AM, resident #5 received Amlodipine 10mg and Prednisone 1mg. These medications were scheduled for 9:00 AM per resident #5?s December 2019 MAR. 2. During interview, staff #1 and staff #2 acknowledged the aforementioned medications for resident #2, resident #3, and resident #5 were not administered in accordance with the facility?s standard dosing schedule.
Plan of Correction:	The clinical coordinator will evaluate each resident?s medication administration time to ensure medication times are appropriate in order to be compliant with the facilities dosing schedule. Staff #2 will educated on the dosing schedule and will be observed by the AL Director during routine medication administration for a total of 3 days. The AL Administrator will review medication timeliness monthly for 3 months.
Standard #:	22VAC40-73-680-D
Description:	Based on observation, record review, and interview, the facility failed to ensure medications are administered in accordance with the physician?s instructions. Evidence: 1. During the morning medication pass observation, staff #2 was observed administering resident #5?s medications to include 1 tablet of Calcium Carbonate 500mg. Staff #2 instructed resident #5 to chew the Calcium Carbonate 500mg tablet and resident #5 was observed chewing the tablet. 2. During resident #5?s record review with staff #1, the current physician?s orders on file dated 12-09-2019 documented ?Calcium Carbonate 500mg (1,250mg)-vitamin D3 400 unit tablet. The order did not specify/document to ?Chew? the Calcium Carbonate 500mg tablet. Staff #2 did not administer the Calcium Carbonate 500mg tablet to resident #5 in accordance with the physician?s instructions. 3. Additionally, during the morning medication pass observation with staff #2, the following was observed: A. Resident #3?s December 2019 Medication Administration Record (MAR) documented for the resident to receive 2 tablets of Potassium Chloride ER 20 mEq. B. Staff #2 placed resident #3?s medications into a pill cup, to include 1 tablet of Potassium Chloride ER 20 mEq. C. Before staff #2 placed resident #3?s medications back into the medication cart, the Licensing Inspector informed staff #2 that only 1 tablet of Potassium Chloride ER 20 mEq was observed in the pill cup. D. Staff #2 acknowledged there was only 1 tablet of Potassium Chloride ER 20 mEq in resident #3?s pill cup, instead of 2 tablets per the physician?s order. 4. During resident #3?s record review with staff #1, the current physician?s orders dated 11-13-2019 documented ?potassium chloride ER 20 mEq tablet, extended release (2 tabs).? 5. During interview, staff #1 and staff #2 acknowledged resident #3 and resident #5?s medications were not administered in accordance with the physician?s instructions.
Plan of Correction:	Resident #5 medications were reviewed to ensure orders were consistent with medications that indicate chewable tablets. The clinical coordinator will review all residents? medications to ensure orders are consistent with medications that indicate chewable tablets and other special instructions. Staff #2 will educated on medication administration and will be observed by the AL Director during routine medication administration for a total of 3 days. The AL Director and Clinical Coordinator will provide education to all staff members on physician?s orders, PRN medications and special instructions.