The Harbor at Renaissance
422 William Mills Drive
Stanardsville, VA 22973
(434) 985-4481
Current Inspector: Sarah Pearson (540) 680-9469
Inspection Date: April 13, 2022
Complaint Related: No
- Areas Reviewed:
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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
63.2 General Provisions.
63.2 Protection of adults and reporting.
22VAC40-90 Background Checks for Assisted Living Facilities
22VAC40-90 The Sworn Statement or Affirmation
22VAC40-90 The Criminal History Record Report
- Technical Assistance:
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1. It is highly recommended that units be added to the MAR for sliding scale insulin to monitor administration. This recommendation was also made in a previous inspection.
2. Discussed how a MAR is a legal document and stands alone and should be reviewed and regarded as such.
3. Admission paperwork was signed as required by the POA or resident as required but not consistently signed by facility staff - these are legally binding documents as well.
4. Hospice plans should be included with ISP aside from simply noting the service and agency. This also applies to any other outside agency providing additional services to residents.
- Comments:
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Two licensing inspectors completed this unannounced monitoring inspection. Four staff files plus additional new staff background checks were reviewed. an additional Four resident files along with four additional medication administration records were reviewed. Outside inspections were current as were related drills. All postings were as required. Pharmacy, dietary and health care oversight were all current. The facility has been doing remodeling and both families and residents like the change. Four violations were identified during the inspection. Details can be found in the violations portion of this report. Areas of non compliance were scope of practice, medication administration, medication documentation, and follow up on admission information.
Thank you to the residents, families and staff for your cooperation during this monitoring inspection. Should you have additional questions or concerns please call (540) 292-5930 or email this inspector at sharon.deboever@dss.virginia.gov.
- Violations:
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Standard #: 22VAC40-73-200-B Description: Based on a review of medication administration records and physician orders, documentation indicated that medication aides caring for residents with special health care needs provided services outside of their scope of practice and training as per Board of Nursing guidelines. According to the physical of resident C the resident was admitted to the facility February 21st with a stage III healing ulcer. The physician wrote an order for application of medihoney as follows "apply topically to sacrum every evening until healed for treatment". This treatment was documented as provided by medication aides from 2/21 through 3/3 when it was discontinued. Registered medication aides are not qualified to provide wound care except in the case of basic first aid. Plan of Correction: Based on a nursing assessment upon admission staff indicated they thought it was healed but the physician's order noted apply until healed. The nurses will be responsible for reviewing all future orders at time of admission or as needed related to pressure area treatment to determine who can be responsible for carrying out the treatment. This review will also be included in the health care oversight.
Standard #: 22VAC40-73-320-A Description: Based on a review of the physical in the record for resident D the facility failed to acknowledge or document receipt of clarification or follow up information for the tuberculosis status noted in the record. It was confirmed during the exit meeting discussion that the admitting staff were unaware of the information provided in the physical document. Plan of Correction: Immediate attention will be paid to clarifying the admitting tuberculosis diagnosis for resident D with attending physician and documented accordingly. In the future nursing staff will review all admitting physical information and seek clarification on any questionable items listed prior to admitting the individual with a possible exception for emergency admissions. In those cases clarification will be obtained at the time of the physical as applicable. This information will be documented in the file and the administrator made aware of any conditions of concern. Monitoring this will be included in the health care oversight process.
Standard #: 22VAC40-73-650-B Description: Based on a review of medication administration records and physician orders, the orders were incomplete for resident G:
No Diagnosis:
Greers Goo - apply to buttocks 2 times a day until resolved
Hydrocortisone Cream - Apply topically to right back 3 times a day until resolved
Geri Sleeves - apply sleeves to both legs daily
Duplicate Orders:
Two identical orders for morphine except one is for every two hours and one for every four hours plus two orders for acetaminophen for pain; there is further no indication what order they should be used in and resident is not capable of requesting.
Resident has no diagnosis of diabetes but order is for using diabetic tussin for coughPlan of Correction: Immediate correction will be to secure clarification of the orders described from physician. Nursing staff will review all medication administration records for completeness and secure any needed information. All future orders will be reviewed for clarification and completeness prior to sending to the pharmacy or being added to the medication administration record. Nursing staff is responsible for correction and continued compliance.
Standard #: 22VAC40-73-680-I Description: Based on a review of medication administration records facility staff failed to administer and/or document the administration of medication correctly as per physician orders and Board of Nursing guidelines and training:
Resident F:
March 12th Blood glucose level was 71 (6:48pm) - lantus was given but physician was not notified of low blood sugar
March 12th Sliding scale blood glucose level was 92 (7:58am) sliding scale administration starts at 150 - documentation indicates insulin lispro was given
Initials are circled with no corresponding comments
Resident G:
March 17th and 21st - Treatment scheduled for 8 pm - documented as completed at 11:06pm and 11:51pm respectively
March 25th - Geri sleeves are to be applied to both legs daily - comment notes "these were washed and will apply when dry" (1:11pm)
Resident H:
Order for sliding scale insulin - humalog Kwikpin with administration not starting until blood glucose level is 150 or higher - Mar 1 blood glucose level was 101 (8am) and comment says treatment given. Since the document does not indicate number of units given the MAR currently reflects documentation that would indicate insulin was given over 95% of the time when blood glucose level did not require it. Initials are not circled or notes provided with the exception of 7pm on March 18th.
March 14th - staff notes medication was "Late: was with a resident"Plan of Correction: Nursing staff will provide additional training regarding documentation on the medication administration for all medication administration aides. Units will be added to the MARs to better discern whether medication is or is not being administered. Physicians will be asked to clarify parameters, especially as it relates to insulin usage and blood glucose level monitoring as well as the use of PRN medication to determine when the physician should be notified and when certain medications should be held. This will also be incorporated into training for the medication aides and nurses assisting with medication administration.
As noted in a previous violation this will be included when reviewing orders prior to them being sent to the pharmacy or added to the MAR by facility staff. The nursing staff assumes responsibility for corrections and future compliance under the direction of the administrator.
Disclaimer:
This information is provided by the Virginia Department of Social Services, which neither endorses any facility nor guarantees that the information is complete. It should not be used as the sole source in evaluating and/or selecting a facility.
This information is provided by the Virginia Department of Social Services, which neither endorses any facility nor guarantees that the information is complete. It should not be used as the sole source in evaluating and/or selecting a facility.