VIRGINIA DEPARTMENT OF SOCIAL SERVICES

The Village at Orchard Ridge
400 Clocktower Ridge Drive
Winchester, VA 22603
(540) 431-2800

Current Inspector: Jill James (540) 418-2631

Inspection Date: Sept. 24, 2021

Complaint Related: No

Areas Reviewed:

22VAC40-73 RESIDENT CARE AND RELATED SERVICES

Technical Assistance:

Recommended physician's orders and medication administration records reflect half a tablet by using 1/2 tablet rather than 0.5 tablet .

Comments:

A non-mandated self-report inspection was initiated on 9/24/2021 and concluded on 9/24/2021. A self-reported incident was received by the department regarding allegations in the area 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 self-report of non-compliance with standards or law, and violations were issued. All violations can be found on the violation notice.

Violations:

Standard #:	22VAC40-73-680-D
Description:	Based upon documentation and an interview, the facility failed to ensure one medication for one resident was administered according to the physician's order. Evidence: 1. Resident 1 had a physician's order signed 9/9/2021 for, "Ativan Tablet 0.5 MG Give 0.5 tablet by mouth two times a day related to anxiety disorder, unspecified AND give 1 tablet by mouth at bedtime related to anxiety disorder, unspecified." 2. The September medication administration record (MAR) for resident 1 listed, "Ativan Tablet 0.5 MG (Lorazepam) Give 0.5 tablet by mouth two times a day related to anxiety disorder, unspecified" at 9:00 am and 2:00 pm. 3. Progress note for 9/21/2021 at 8:18 am stated, "Ativan Tablet 0.5 MG Give 0.5 tablet by mouth two times a day related to anxiety disorder, unspecified. Medication held due to resident being more drowsy than normal. DON made aware. Staff will continue to monitor." 4. Progress note dated 9/21/2021 at 3: 34 pm stated, Ativan Tablet 0.5 MG Give 0.5 tablet by mouth two times a day related to anxiety disorder, unspecified. Medication held per NP request." 5. Progress note dated 9/21/2021 at 5:51 pm stated, "On 9/21/2021 resident was noted to be drowsy with stable vital signs. A review of medications received in the past 24 hours revealed that on 9/20/2021 resident received 0.5mg of Ativan at 9:37 am, and 1:30 pm instead of 0.25 mg at 9:00am and 2:00pm as ordered. Resident was assessed. She was drowsy but able to arouse when called. She is alert and responsive, oriented to self and place."
Plan of Correction:	Education /in-service on medication administration was provided to the nurse involved and is on-going for all certified medication aides (CMAs) and nurses. Ativan order was discontinued and reordered by nurse practitioner with a clarification order. New orders added to the resident's medication profile will be reviewed by the night nurse and clarification of orders, if needed, on a daily basis. All new orders will be reviewed weekly by the director of nursing (DON). All nurses and CMAs working on the neighborhood will be educated on medication administration rights. Quarterly medication administration observations will take place. Resident's new orders will be reviewed on a weekly basis by the DON. Any actionable trends or patterns will be reported monthly to the Quality Assurance Performance Improvement (QAPI) committee. The DON, administrator or designee will be responsible to ensure compliance.