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: Sept. 1, 2021

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 RESIDENT CARE AND RELATED SERVICES

Comments:

A non-mandated complaint inspection was initiated on 09/01/2021 and concluded on 09/20/2021. A complaint was received by the department regarding allegations in the areas of resident care and related services. The administrator was contacted by telephone to conduct the investigation. The licensing inspector emailed the administrator a list of documentation required to complete the investigation. The evidence gathered during the investigation supported the allegation of non-compliance with standards or law, and violations were issued. Any violations not related to the complaint but identified during the course of the investigation can be found on the violation notice.

Violations:

Standard #:	22VAC40-73-450-D
Complaint related:	No
Description:	Based on document review, the facility failed to ensure the Individualized Service Plan (ISP) included services provided by hospice. EVIDENCE: 1. The Individualized Service Plan dated 07/21/21 for resident 1, indicates resident receives hospice care and staff will follow the hospice care plan attached and staff to call hospice 24/7 if any concerns or needs of residents. 2. The hospice care plan for resident 1 was not included with the ISP dated 07/21/2021. 3. The Individualized Service Plan dated 07/21/21 for resident 1 does not include a description of hospice services provided as required.
Plan of Correction:	Administrator will assure all ISPs are complete and accurate. ISP audit/review will be completed by administrator.
Standard #:	22VAC40-73-450-E
Complaint related:	No
Description:	Based on record review, the facility failed to ensure the Individualized Service Plan (ISP) are signed and dated by the resident or his legal representative. EVIDENCE: The Individualized Service plan for resident 1, dated 07/21/2021 is not signed by the resident or his legal representative.
Plan of Correction:	Administrator will assure all ISPs are presented for signature to appropriate resident or legal representative upon completion of audit/review.
Standard #:	22VAC40-73-680-D
Complaint related:	Yes
Description:	Based on document review, the facility failed to ensure medications are administered in accordance with the physician's or other prescriber's instruction and consistent with the standards of practice outlined in the current medication aide curriculum approved by the Virginia Board of Nursing. EVIDENCE: 1. The record for resident 1 contained the following physician's order dated 01/13/2021: Morphine SF 20mg/ML: Take 0.25ml (5mg) by mouth every 2 hours as needed. 2. Hospice nursing note dated 06/28/2021 at 12:50pm indicates "Nurse is unsure of exact amount morphine administered. Nurse instructed that staff try Lorazepam as next intervention in case patient did take an excess of morphine last night." 3. The June Medication Administration Record (MAR) for resident 1 confirms that Morphine was administered at 1:40pm prior to the Lorazepam, that was administered at 5:38pm.
Plan of Correction:	Administrator will coordinate a medication aide in-service on medication administration with facility pharmacy nurse. Staff involved in medication administration in this case will complete medication administration refresher course.