VIRGINIA DEPARTMENT OF SOCIAL SERVICES

The Harbor at Renaissance
422 William Mills Drive
Stanardsville, VA 22973
(434) 985-4481

Current Inspector: Sarah Pearson (540) 680-9469

Inspection Date: June 3, 2020 and June 4, 2020

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 EMERGENCY PREPAREDNESS 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS Article 1 Subjectivity 22VAC40-90 Background Checks for Assisted Living Facilities 22VAC40-90 The Sworn Statement or Affirmation 22VAC40-90 The Criminal History Record Report

Technical Assistance:

Be sure and have physician include a source for the oxygen on their order, transcribe to the MAR and have on service plan (refer residents B and C). Census: 52

Comments:

This inspection was conducted by licensing staff using an alternate remote protocol necessary due to a state of emergency health pandemic declared by the Governor of Virginia. A monitoring inspection was initiated on 6/01/2020 and concluded on 6/03/2020. The administrator and director of nursing were contacted by email to initiate the inspection. The administrator reported that the current census was 52. The inspector emailed the administrator and director of nursing a list of time required to complete the inspection. The inspector reviewed four resident charts including notes and 4 additional medication records.Discharge assistance planning agreements were also reviewed. Four staff records were reviewed that included training,any certification requirements and staff scheduling. The inspection also included review of fire and health inspections, emergency drills, health care, dietary and pharmacy over site all submitted by the facility to ensure documentation was complete. Information gathered during this monitoring inspection determined non-compliance with one applicable standard or law, and the violation was documented on the violation notice issued to the facility. Thank you to staff and administration for your patience and assistance during this desk review process. Should you have additional questions or concerns please call (540) 332-2330 or e-mail this inspector at sharon.deboever@dss.virginia.gov.

Violations:

Standard #:	22VAC40-73-680-K
Description:	Based on review of physician orders and medication administration records (MARs), resident A has hospice medication with multiple diagnosis for use, resident B has 2 medications for pain as does resident E who also has 2 medications for nausea. Resident G has a PRN/as needed medication noted for schizophrenia. All these individuals reside in a memory care facility so cannot ask for medication. The staff should further be describing what they are seeing to represent such diagnosis as anxiety or aggression and not just the diagnosis when administering medication. (Note: It would appear all medication has been discontinued for resident H)
Plan of Correction:	Orders will be clarified when respective physician. Staff will receive additional documented training regarding the use of PRN medication and documentation. The administrator in conjunction with the director of nursing will ensure correction and future compliance and monitoring.