VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Timberview Crossing
351 New Market Road
Timberville, VA 22853
(540) 896-9858

Current Inspector: Jill James (540) 418-2631

Inspection Date: Dec. 2, 2019

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 ACCOMODATIONS AND RELATED PROVISIONS 22VAC40-73 BUILDING AND GROUNDS 22VAC40-73 EMERGENCY PREPAREDNESS 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS Article 1 Subjectivity 32.1 Reported by persons other than physicians 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

Technical Assistance:

Conversation occurred on the following topics: 1) Ensure all insulin orders contain parameters as it relates to holding and notification to physician. 2) Reviewed condition of carpet as it relates to replacement in room #18. 3) Ensure resident rights and orientation are reviewed with the resident and acknowledgment is signed by resident and not just the legal representative. 4) Mobility refers to movement outside of the facility. 5) Ensure all mechanical supports are identified on the ISP. 6) Indicate all services provided by hospice on the ISP.

Comments:

The information contained in this renewal inspection report will be reviewed by the licensing administrator. The facility will be notified by mail regarding their renewal status. An unannounced renewal inspection was conducted by two LIs on 12/02/2019. There were 33 residents in care. The facility was clean and free from any foul odors. The menu and activity calendar reflected what the LIs observed. All postings were current as were related drills. Physician's orders and medication administration records were reviewed for a selected number of residents. Six resident, one discharge and four staff records were reviewed. Criminal history reports were reviewed for all staff hired since the last inspection. There were four violations during this renewal inspection. Details of non-compliance can be viewed in the violation notice section of this report. If you have any questions, please contact the licensing inspector at (540) 332-2330.

Violations:

Standard #:	22VAC40-73-680-D
Description:	Based upon review of residents' records, the facility failed to ensure medications are administered in accordance with the physician's instructions and consistent with the standards of practice outlined in the current registered medication aide curriculum approved by the Virginia Board of Nursing. EVIDENCE: 1) Resident A has the following order: Novolin R 100 units/ml vial-Inject subcutaneously three times a day per the sliding scale; less than 149=0; 150-200=4Units; 201-250=5Units, 251-300=6Units; 301-350=8Units; 351-400=10Units; 401-450=12Units; 451-500=14Units; greater than 500 call MD. a. Documentation in the electronic medication administration record indicates resident's blood glucose was 305 on 11/02/19 at 5:00pm and resident received 6 units of insulin. Resident should have been administered 8 units. 2) Resident G has the following orders: Check weight every morning before breakfast. If weight increases greater than 3lbs in 5 days, see order for Fursosemide; Furosemide 20mg-Take 1 tablet by mouth as needed for O2 desaturation or weight gain of 3lbs or more in 24 hours. a. Documentation in the electronic medication administration record indicates resident's weight was 168 on 11/15/19, 173 on 11/16/19, 175 on 11/18/19, 176 on 11/20/19, 173 on 11/25/19 and 176 on 11/26/19. a. There is no documentation of Furosemide being administered from the PRN order or notification to physician for the month of November. b. There is no documentation of O2 saturation reading in the electronic medication administration record for November. 3) Resident H has the following order: Calcitonin-Salmon 200IU spray-Spray one puff into the left nostril every other day. a. Documentation in the electronic medication administration record indicates medication was administered in the left nostril on 11/21/19 and on 11/22/19. 4) Resident H has the following order: Oxycodone APAP 5-325mg-Take one by mouth every 6 hours as needed for pain. a. Documentation in the electronic medication administration record indicates medication was administered on 11/05/19 at 3:46pm and again at 9:10pm; on 11/07/19 at 4:04pm and again at 9:48pm; on 11/15/19 at 7:59am and again at 12:37pm; on 11/22/19 at 8:13pm and again on 11/23/19 at 1:18pm; on 11/23/19 at 4:29pm and again at 10:11pm. b. Resident H has an order that if PRN medications are not effective, to notify the physician in 72 hours. There is no documentation of physician notification. 5) Resident H has the following order: Tramadol 50mg-Take one tablet by mouth every 6 hours as needed for pain. a. Documentation in the electronic medication administration record indicates medication was administered on 11/01/19 at 4:05pm and again at 8:00om; on 11/03/19 at 3:18pm and again at 8:12pm. b. Resident H has an order that if PRN medications are not effective, to notify the physician in 72 hours. There is no documentation of physician notification. 6) Resident J has the following orders: Oxycodone 5mg-Take 2 tablets by mouth three times a day for pain; Oxycodone 5mg- Take 1 tablet by mouth every 6 hours as needed for pain at least 4 hours between scheduled and PRN doses. a. Documentation indicates scheduled medication time is 7:00am, 2:00pm and 8:00pm. b. Documentation indicates PRN Oxycodone was administered on 11/09/19 at 11:11am and scheduled dose was administered at 2:00pm. Due to the amount of evidence gathered during this inspection, additional information is included in a separate document on file in the licensing office and is available upon request.
Plan of Correction:	Administrator or designee will refresh all RMAs on blood glucose monitoring, insulin administration, reviewing doctor's orders, and documentation. Documentation and training will be kept on file. Administrator or designee will monitor eMARs 3-4 times per month for 1 month. If compliance is in accordance with regulations, then Administrator or designee will monitor monthly for 6 months. Documentation will be kept on file.
Standard #:	22VAC40-73-680-G
Description:	Based upon direct observation, the facility failed to ensure over-the-counter medication are labeled with the resident's name: EVIDENCE: 1) Upon inspection of the back hall medication cart, the LI observed containers of aspirin, B-12, and Centrum Silver that did not contain resident's name. 2) Upon inspection of the treatment cart, the LI observed a container of probiotic that did not contain a resident name.
Plan of Correction:	The administrator or designee will refresh all RMAs on proper labeling of all prescription and OTC medications. Administrator or Designee will monitor medication/treatment carts 3-4 times a month for 1 month. If compliance is in accordance with regulations, then the Administrator or Designee will monitor monthly for 6 months. Documentation will be kept on file.
Standard #:	22VAC40-73-680-I
Description:	Based upon review of residents' medication administration records, the facility failed to ensure all required information is included in the electronic MAR. EVIDENCE 1) The treatment administration record for resident H does not include the initials of staff person for administration of Skin Sake Protectant ointment on 11/02/19 at 8:00pm and 11/04/19 at 5:00pm. 2) The medication administration record for resident H does not include the initials of staff person for administration of Acetaminophen on 11/04/19 at 5:00pm; Docusate on 11/04/19 at 5:00pm; Ensure on 11/04/19 at 5:00pm; Guaifenesin on 11/02/19 at 8:00pm; Ipratpropium spray on 11/02/19 at 8:00pm; Ketorolac on 11/02/19 at 10:00pm; Levetiracetam on 11/04/19 at 5:00pm and Montelukast on 11/04/19 at 5:00pm. 3) There is no followup from results of PRN administration Tramadol for resident H on 11/01/19 at 9:12am "resident still having pain, family was notified.";11/01/19 8:00pm "still in pain."; 11/02/19 at 7:38am "pain continues-will give more PRN if pain continues"- no other PRN was administered until 2:37pm; 11/03/19 at 7:18am "pain continues will give more PRN if pain continues"-no other PRN was administered until 3:18pm. 4) There is no follow-up from PRN administration of Oxycodone on 11/15/19 at 8:25pm. Results indicate "pain continues will give more PRN if pain continues." There is no further follow-up; on 11/20/19 t 7:41am results indicates "resident still complaining of pain." ; 11/22/19 at 6:44am results indicate" pain continues will give more PRN if pain continues." There is no further followup documented until administration of Acetaminophen at 5:02pm. 5) There is no follow-up from PRN administration of Robafen for resident I on 11/07/19 at 7:30am. Results indicate "still coughing will give another PRN." There is no additional PRN administered on 11/07/19. 6) There is no follow-up from PRN administration of Cyclobenzaprine for resident L on 11/04/19 at 9:07pm. Results indicate "continues will give more PRN." There is no further administration of PRN medication on 11/04/19; 11/16/2019 at 8:51pm. Results indicate "pain continues will give more PRN if pain continues." There is no further administration of PRN medication on 11/16/19. 7) There are no initials of staff for administration of Lorazepam for resident M on 11/22/19 at 5:00pm. 8) There is documentation of physician notification or refusal form completed for refusals on 11/16/19 and 11/25/19. 9) There is no followup from PRN administration of Lorazepam on 11/15/19 at 3:15pm. Results indicate "resident still being very agitated."
Plan of Correction:	Administrator or Designee will refresh all RMAs on the use of PRNs and documentation. Administrator or Designee will monitor eMARs 3-4 times per month for 1 month. If compliance is in accordance with regulations, the Administrator or Designee will monitor monthly for 6 months. Documentation will be kept on file
Standard #:	22VAC40-73-860-I
Description:	Based upon direct observation, the facility failed to ensure cleaning supplies and other hazardous materials are stored in a locked area. During a walk through of the facility, the LI observed the laundry room door open and unattended in the back hallway. The area contained laundry detergent, carpet cleaner and sanitizing solution.
Plan of Correction:	The administrator or Desingee will refresh all staff and residents on securing all potentially hazards by making sure Laundry door is kept secured.