VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Kingston Center
428 Cecil D. Quillen Drive
Thomas Village
Duffield, VA 24244
(276) 431-4200

Current Inspector: Rebecca Berry (276) 608-3514

Inspection Date: Feb. 26, 2020

Complaint Related: No

Areas Reviewed:

22VAC40-73 GENERAL PROVISIONS 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

Technical Assistance:

Please ensure the last page of the resident rights information located in resident files for new admits contain the correct information for the most current licensing supervisor and phone number listed.

Comments:

Three licensing inspectors conducted a one day unannounced mandated renewal inspection at Kingston Center on 02/26/2020. The inspection started at 10:05 am and concluded at 1:26 pm. The facility had 103 residents in care on the day of inspection. A sample of resident and staff files were reviewed. Required postings were checked. The noon medication pass was observed and medication cart audits were conducted. Lunch and snacks were observed being served. Activities were observed along with staff interactions with residents throughout the inspection. An exit meeting was held with the administrator and other key staff on 02/26/2020 and at that time opportunity was given to find items not available in files. As a result of this inspection 12 violations are being cited. Please develop a plan of correction for each of the cited violations along with a date of correction and return a signed and dated copy back to the licensing office within 10 calendar days (03/22/2020 ) of receipt. If you have any questions or concerns please contact your inspector at 276-608-3514. Thank you for your cooperation and assistance.

Violations:

Standard #:	22VAC40-73-100-C-1
Description:	Based on observations made during the morning medication pass, the facility failed to implement their infection control program and did not use practices consistent with the Center for Disease Control (CDC) recommendations for blood glucose monitoring practices. EVIDENCE: 1. Staff # 4 did not place a protective barrier down on the medication cart, nor did she sanitize the top of the medication cart prior to checking blood glucose levels on two residents.
Plan of Correction:	All nursing staff has had a refresher course/in service in the facility's infection control program. Staff also has had a refresher in the CDC's recommendation for blood glucose monitoring. The DON will monitor that the policies are being followed daily. [sic]
Standard #:	22VAC40-73-200-C
Description:	Based on observations made and staff statements, the facility failed to train all direct care staff who were providing care to residents. Evidence: Staff # 6 stated she had placed resident # 11's full bed rails in the upright position upon the resident?s request. This staff person is a housekeeper and is not trained as a direct care staff.
Plan of Correction:	All bed rails have been removed throughout the facility. A staff training was conducted on 2/28/2020 with staff including the topic of scope of practice for every department. The Department heads for each department will ensure that each employee stays within the scope of their job duties. [sic]
Standard #:	22VAC40-73-380-B
Description:	Based on a review of resident records, the facility failed to keep all personal and social information current on one resident in care. Evidence 1. Resident # 11 was admitted to the facility on 08/24/2015. She had a guardian appointed in 2016.Her file only contained one page of the guardianship order and not the entire document.
Plan of Correction:	The entire guardianship order is in the process of being obtained by the facility. The Administrator will ensure that the facility has the complete document when a new guardian is appointed. [sic]
Standard #:	22VAC40-73-650-A
Description:	Based on observations made during the noon medication pass, the Medication Administration Record (MAR) and physician?s orders, the facility failed to follow physician orders to crush medications and place in applesauce for two residents in care. EVIDENCE: 1. Resident # 14 is prescribed Oxycodone-Acetaminophen 10-325 mg, take one tablet by mouth four times daily for pain. There is a physician?s order to crush oxycodone and place in applesauce. When Staff # 4 administered the medication she did not place the crushed medication in applesauce, she placed it in a souffle cup and gave to resident along with a cup of water. 2. Resident # 13 is prescribed Oxycodone-Acetaminophen 7.5-325 mg, take one tablet by mouth every six hours for pain, hold for sedation. There is a physician?s order to crush and place all medications in applesauce. When Staff # 4 administered the medication she did not place the crushed medication in applesauce, she placed it in a souffle cup and gave to the resident along with a cup of water. 3. Both residents have a history of cheeking medications which is why the pills were ordered to be crushed and placed in applesauce.
Plan of Correction:	All nursing staff has had a refresher/in service in following physician's orders. The DON will ensure that physician's orders are being followed daily. [sic]
Standard #:	22VAC40-73-680-D
Description:	Based on observations made during the morning medication pass, the facility failed to administer all medications consistent with the standards of practice outlined in the current registered medication aide curriculum approved by the Virginia Board of Nursing. EVIDENCE: 1. Resident # 12 is prescribed Rulox Suspension give 30 mls by mouth every four hours as needed for acid reflux. This medication was administered on the day of the inspection by Staff # 4 as requested by the resident. Licensing Inspector did not hear Staff # 4 ask Resident # 12 for symptoms prior to administering this PRN (as needed) medication. 2. On the back of the Medication Administration Record (MAR) Staff # 4 recorded the amount given, the route, symptoms given for, and recorded that resident ?states relief?. Staff # 4 did not record the time of symptom relief.
Plan of Correction:	All nursing staff has had a refresher/in service on the standards of practice outlined in the current registered medication aide curriculum approved by the Virginia Board of Nursing. The DON will monitor that the standards of practice are being followed daily. [sic]
Standard #:	22VAC40-73-700-1
Description:	Based on the review of the Medication Administration Records (MARs) and physician?s orders, the facility failed to ensure a valid physician?s or other prescriber?s order included the oxygen source, such as compressed gas or concentrators on one oxygen therapy order. EVIDENCE: 1. Resident # 13 is prescribed Oxygen, 2 liters via nasal cannula at bedtime for congestive heart failure. Resident # 13?s physician?s or other prescriber?s order did not specify the source of the oxygen.
Plan of Correction:	The facility has obtained valid physician's orders for oxygen to residents. All oxygen orders have been updated on the MAR's and ISP's. The DON will ensure that any new oxygen order has the appropriate source. [sic]
Standard #:	22VAC40-73-710-C
Description:	Based on observations made during the morning tour of the building and review of resident records, the facility failed to obtain a physician?s order before using a restraint on one resident in care. Evidence 1. Resident # 11 was observed with a full bed rail engaged and the opposite side of the bed was up against the wall preventing the resident from exiting the bed. The resident was also unable to disengage the rail and stated the rail was to keep her from falling out of bed. There was no physician?s order for this full bed rail.
Plan of Correction:	All bedrails have been removed throughout the facility. The DON will ensure that the facility will obtain a physician's order before using a restraint with any resident. [sic]
Standard #:	22VAC40-73-860-G
Description:	Based on thermometer readings, the facility failed to maintain water temperatures between 105 and 120 degrees F at all hot water taps available to residents. Evidence 1. The bathroom in Room C15 had water temperatures which measured 91.5 degrees F and the water temperature in the C Hall shower room measured 91.2 degrees F.
Plan of Correction:	Temperatures are monitored and logged regularly. Maintenance has adjusted water temperature to be in acceptable range and monitor weekly. [sic]
Standard #:	22VAC40-73-860-I
Description:	Based on observations made during the tour of the building, the facility failed to store all cleaning supplies and other hazardous materials in a locked area. EVIDENCE: 1. A 32 fluid ounce bottle of Opti-Buff Spray Buffer and Restorer was found in the staff break room unlocked and unattended. The door to the break room had a push button combination lock on the door, but when this Licensing Inspector pushed on the door, it easily opened.
Plan of Correction:	The lock on the break room door has been replaced. Maintenance staff will monitor daily that all cleaning supplies and other hazardous materials are stored in locked areas. [sic]
Standard #:	22VAC40-73-870-A
Description:	Based on observations made during the morning tour of the building, the facility failed to maintain the building in good repair. Evidence: 1. Room B16 had a white film covering much of the bathroom floor. 2. Room B21 had a scuffed wall behind the bed and at the bathroom door. 3. Room C4 had a scuffed wall and door facing at the bathroom entrance.
Plan of Correction:	The bathroom floor in B16 has been cleaned. The wall behind the bed and the bathroom door in B2 has been painted. The wall and door facing the bathroom entrance in room C4 has been painted. Maintenance staff will monitor weekly to ensure that the building is maintained in good repair. [sic]
Standard #:	22VAC40-73-870-E
Description:	Based on observations made during the morning tour of the building, the facility failed to maintain all furnishings in good repair. Evidence: 1. The shower room in the C Wing had an inoperable commode. 2. The shower room in the C Wing had an inoperable shower.
Plan of Correction:	The commode in the shower room on C wing has been fixed. The shower in the C wing shower room has been repaired. Maintenance staff will check daily to maintain all furnishings. [sic]
Standard #:	22VAC40-73-980-H
Description:	Based on observations made during the tour of the building, the facility failed to ensure the availability of at least 48 hours of drinking water is available on site. EVIDENCE: 1. The facility was found to have a total of 206 16.9 ounce bottles of water. According to an emergency preparedness website, it is recommended to have one gallon per resident/staff per day on hand.
Plan of Correction:	The facility has obtained the recommended amount of drinking water on site. The Dietary Supervisor will monitor for compliance weekly. [sic]