VIRGINIA DEPARTMENT OF SOCIAL SERVICES

The Gardens of Virginia Beach
5620 Wesleyan Drive
Virginia beach, VA 23455
(757) 499-4800

Current Inspector: Donesia Peoples (757) 353-0430

Inspection Date: April 30, 2020 and May 1, 2020

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 RESIDENT CARE AND RELATED SERVICES

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 complaint inspection was initiated on April 30, 2020 and concluded on May 1, 2020. A complaint was received by the department regarding allegations in the areas of resident care and related services and staffing. 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. The following was discussed: Maintenance of medication storage and training on medication documentation. Please review, sign, date, and return the Violation Notice, Supplemental, and Summary pages to include your facility's plan of corrections. Please submit your ?plan of correction? and ?date to be corrected? for each violation cited on the violation notice in a Word document and return it within 10 calendar days. The plan of correction must indicate how the violation will be or has been corrected. The plan of correction must include: 1. Step(s) to correct the noncompliance with the standard(s) 2. Measures to prevent reoccurrence 3. Person(s) responsible for implementing each step and/or monitoring any preventative measures. Additionally, please contact me if you would like to review your Violation Notice via phone.

Violations:

Standard #:	22VAC40-73-680-C
Complaint related:	Yes
Description:	Based on record review and interview, the facility failed to ensure medications were administered not earlier than one hour before and not later than one hour after the facility?s standard dosing schedule. Evidence: 1. Resident #1?s nurse?s notes dated 02-14-20 10 a.m. documented, ?NP S. Coulson made aware resident did not receive 6AM meds. No noted effects to resident.? Resident #1?s February 2020 Medication Administration Record (MAR) documented resident was to receive Alphagan F 0.1% drops at 6:00 a.m. 2. Resident #2?s nurse?s notes dated 02-16-20 10:00 a.m. documented, ?Late Entry for 2/14/20. NP S. Coulson made aware resident did not receive 6 AM meds. No noted effects to resident.? Resident #2?s February 2020 MAR documented resident was to receive Levothyroxine Sodium 125 mcg and Omeprazole 20 mg at 6:00 a.m. 3. Resident #3?s nurse?s notes dated 02-14-20 8:45 a.m. documented, ?This writer faxed [physician?s office] to make [physician] aware resident did not receive 6A medications. No adverse effects noted. Will await further orders.? Resident #3?s February 2020 MAR documented resident was to receive Furosemide 20 mg, Omeprazole 20 mg, Amlodipine Besylate 5 mg, Finasteride 5 mg, Losartan Potassium F/C 50 mg, Metamucil, Mybertriq F/C 50 mg, Pravastatin Sodium 40 mg, and Tamsulosin HCL 0.4 mg at 6:00 a.m. 4. Resident #4?s nurse?s notes dated 02-14-20 10:00 a.m. documented, ?NP S. Coulson made aware resident did not receive 6 AM meds. No noted effects to resident.? Resident #4?s February 2020 MAR documented resident #4 was to receive Levothyroxine Sodium 150 mcg, Omeprazole 20 mg, and Tramadol HCL F/C 50 mg at 6:00 a.m. 5. Staff #2 acknowledged the aforementioned medications were not administered in adherence to the facility?s standard dosing schedule.
Plan of Correction:	Steps to correct the noncompliance with the standard Resident?s #1, 2, 3 and 4 had no negative outcomes related to missed does of medications. Resident?s medical practitioner made aware of missed doses of medications. All Resident?s medications must be properly administered not earlier than one hour before and not later than one hour after the facility?s standard dosing schedule. DRC/ Designee will conduct and in-service with all LPN's and Medication Aides regarding the medication management plan related to proper time frame for administering resident?s medications to comply with state regulations Measures to prevent the noncompliance from occurring again DRC/Designee will complete medication pass observations 2 times weekly for four weeks and then weekly for four weeks with members who administer medications to ensure timely administration of medication beginning 05/15/2020 and ending on 07/10/2020.
Standard #:	22VAC40-73-680-I
Complaint related:	Yes
Description:	Based on record review and interview, the facility failed to ensure the Medication Administration Record (MAR) included any medication omissions. Evidence: 1. The following residents? MARs documented initials that were circled by medication administration staff, that the MAR code documented "Circle initials when medication refused", indicating the medications were not given for the following: A. Resident #4?s March 2020 MAR on 03-18-20 for Senexon-S 8.6mg ? 50mg, B. Resident #5?s March 2020 MAR on 03-17-20 for Melatonin 3 mg and Mirtazapine F/C 7.5 mg, and for 03-17-20 and 03-18-20 for the following medications: Levothyroxine Sodium 125 mcg, Famotidine F/C 20 mg, Gas-X 125 mg, Potassium Chloride 20 MEQ/15 ML, Xarelto F/C 15 mg, and Systane 0.3%/0.4% eye drops, C. Resident #7?s February 2020 MAR on 02-08-20, 02-09-20, and 02-12-20 for Augmentin 500-125 mg, D. Resident #1?s February 2020 MAR on 02-14-20 for Memantine HCL F/C 50 mg, E. Resident #8?s March 2020 MAR on 03-25-20 for Sodium Chloride 1 gm tab, F. Resident #2?s March 2020 MAR on 3-10-20 for Omeprazole 20 mg, 03-25-20 Atorvastatin 20 mg and Lantus 160 u/ml. 2. Staff #2 acknowledged the MARs for the residents did not include medication omissions documenting why medications were not given.
Plan of Correction:	Steps to correct the noncompliance with the standard Residents identified in the violation experienced no negative outcomes related to not receiving scheduled medications. DRC/Designee will conduct an in-service with current LPNs and Medication Aides to ensure their knowledge and understanding of medication administration to include properly recording any medication omissions. Measures to prevent the noncompliance from occurring again Medication Aide refresher class will be scheduled to occur as soon as possible after community is able to admit non-essential visitors. DRC/Designee will complete medication pass observations 2 times weekly for four weeks and then weekly for four weeks with team members who administer medications to ensure compliance beginning 05/15/2020 and ending on 07/10/2020. MARs will be audited by the DRC/designee 3 times a week for 4 weeks, then 2 times a week for 4 weeks, then weekly for 4 weeks to ensure MARs contain complete documentation. To begin 05/25/2020 and end on 08/14/2020.