VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Lovettsville Home Assisted Living
39196 Rodeffer Road
Lovettsville, VA 20180
(540) 822-3824

Current Inspector: Marshall Massenberg (804) 543-5188

Inspection Date: Oct. 18, 2024

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 GROUNDS 22VAC40-73 EMERGENCY PREPAREDNESS 63.2 GENERAL PROVISIONS 63.2 PROTECTION OF ADULTS AND REPORTING 63.2 LICENSURE AND REGISTRATION PROCEDURES 63.2 FACILITIES AND PROGRAMS 22VAC40-90 BACKGROUND CHECKS FOR ASSISTED LIVING FACILITIES 22VAC40-90 THE SWORN STATEMENT OR AFFIRMATION 22VAC40-90 THE CRIMINAL HISTORY RECORD REPORT 22VAC40-80 THE LICENSE 22VAC40-80 THE LICENSING PROCESS

Technical Assistance:

Documentation was discussed with the provider.

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: 10/18/24 (8:20 AM - 1:45 PM) The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. Number of residents present at the facility at the beginning of the inspection: Two The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: Two Number of interviews conducted with residents: One Number of interviews conducted with staff: One Observations by licensing inspector: Meals, medication administration Additional Comments/Discussion: 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 Marshall Massenberg, Licensing Inspector at (804) 543-5188 or by email at Marshall.x.Massenberg@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-490-D
Description:	Based on observation and interview, the facility did not ensure that the specific residents included in the health care oversight are identified. Evidence: 1. Facility health care oversights for the past six months were observed during the inspection. 2. The information included in the comment sections, of the last two oversight forms, almost identical information. 3. No residents were identified on either of the oversight forms that were reviewed during the inspection. 4. Facility staff confirmed that the residents, included in the oversight, were not identified on the form.
Plan of Correction:	Health care oversight did not find any specific medical conditions for any of our residents who should have been identified. However, this is the first time that an inspector has asked us to list the names of all residents in health care oversight, regardless of their medical conditions, for identification purposes. From now on, the facility's health care oversight will provide residents' names on all forms for identification, as requested by the inspector.
Standard #:	22VAC40-73-520-I
Description:	Based on observation, the facility did not ensure that the activity schedule included the hour of each activity. Evidence: 1. The activity schedule was observed. The only activity on the schedule, for 10/18/24, was a library activity. No time was listed to indicate when the activity would take place. 2. No time was listed for any of the activities included on the schedule.
Plan of Correction:	The facility administrator has updated the activity calendar by adding the time for each activity.
Standard #:	22VAC40-73-560-E
Description:	Based on observation, the facility did not ensure that resident records are kept in a locked area. Evidence: The facility's office was observed to be unlocked and unattended at approximately 9:03 AM. Resident records were in an unlocked cabinet in the office.
Plan of Correction:	All residents' records are kept in a locked fil inside a locked room. The administrator opened the file to provide the inspector with the requested residents' charts, and the inspector immediately showed up and asked why the file was open, even though it had only been 20 seconds. The facility will ensure that all files and rooms remain locked, even when inspectors are present in the facility.
Standard #:	22VAC40-73-650-A
Description:	Based on documentation, the facility did not ensure that no medication, dietary supplement, medical procedure, or treatment is started, changed, or discontinued without a valid order from a physician. Evidence: 1. Resident #2's September and October medication administration records (MARs) were observed during the inspection. 2. Resident #2's record contained an order that stated that her Lidocaine patch was to be discontinued on 9/5/24. 3. Resident #2's Lidocaine patch was applied/administered until 10/5/24, when the MAR noted that the Lidocaine patch was discontinued.
Plan of Correction:	The administrator contacted the physician's office regarding the incorrect date for the discontinued medication. The physician's office apologized for their mistake and sent us a new physician's order with the corrected date for this specific medication.
Standard #:	22VAC40-73-650-E
Description:	Based on observation and documentation, the facility did not ensure that the resident record contains the physician?s signed written orders. Evidence: Resident #1's October MAR included Pantaprazole two 20mg tablets (ordered 1/6/24), but the physician's order was not in the resident's record. Resident #2's October MAR included the following medications: Carvedilol 3.125mg, Omeprazole 40mg, Meloxicam 15mg, and Senna 8.6mg. Resident #2's record did not contain physician?s orders for the above medications. Facility staff confirmed that the listed resident physician's orders were not in the resident records, at the time of the inspection.
Plan of Correction:	Based on the inspector's observations all bubble pack medications matched the Medication Administration Record (MAR). This indicates that the pharmacy had the physician's orders and sent the medications and MAR to the facility accordingly. However, family members, the physician's office, and the pharmacy did not send us the orders, despite our ongoing requests for family members to bring hard copies to the facility. The administrator contacted the pharmacy to request a copy of all medications mentioned by the inspector. The facility received a copy of the physician's orders for all these medications and placed them in the residents' charts.