VIRGINIA DEPARTMENT OF SOCIAL SERVICES

The Waterford at Virginia Beach
5417 Wesleyan Drive
Virginia beach, VA 23455
(757) 490-6672

Current Inspector: Lanesha Allen (757) 715-1499

Inspection Date: June 25, 2019 and June 27, 2019

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 STAFFING AND SUPERVISION 22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS Article 1 Subjectivity

Comments:

An unannounced complaint inspection was conducted by the Licensing Inspector from the Eastern Regional Office. The inspection was conducted on June 25, 2019 from 11:08 AM until 4:39 PM and on June 27, 2019 from 10:25 AM until 3:13 PM. There were 71 residents in care. The complaint alleged concerns regarding medication administration, staffing on the Assisted Living unit, call bell response times, resident admission documentation, and resident activities. During the inspection a medication observation was conducted, staff schedules were reviewed along with the most recent call bell log. Activity calendars were also reviewed. Activities were observed as listed on the calendar. Resident records were reviewed to include information provided at admission as well admission procedures. Staff records were reviewed. Resident and staff interviews were also conducted. During the inspection there was discussion regarding the facility's admission process and information provided to residents and families during move-in. In addition there was a discussion regarding staffing patterns in the building (assisted living unit and memory care). Discussed staffing based on census and resident acuity. Please update the facility's Disclosure statement to indicate percentage of census when staff numbers listed apply. Menus, meal options and activities were also discussed. Based on the information gathered during this inspection, the complaint was found to be valid due to concerns regarding medication administration. The violations cited were discussed with the Executive Director during the inspection and during the exit interview and can be found on the Violation Notice. Please complete the 'plan of correction' and 'date to be corrected' for each violation cited on the violation notice. Your plan of correction must indicate how the violation will be or has been corrected. Just writing the word 'corrected' is not acceptable. Your plan of correction should include: 1. Step(s) to correct the non-compliance with the standard(s) 2. Methods to prevent reoccurrence 3. Person(s) responsible for implementing each step and/or monitoring any preventive action. If you have any questions please contact your inspector at 757-353-0430.

Violations:

Standard #:	22VAC40-73-1130-A
Complaint related:	No
Description:	Based on record review and interview, the facility failed to ensure when 20 or fewer residents are present, at least two direct care staff members shall be awake and on duty at all times in each special care unit who shall be responsible for the care and supervision of the residents. For every additional 10 residents, or portion thereof, at least one more direct care staff member shall be awake and on duty in the unit. Evidence: 1. During review of the staff work schedules for April 2019, the facility failed to maintain 3 staff on the memory care unit on 04-08-2019 and 04-09-2019. The schedule indicated staff # 5, #7, and #8 were scheduled to work 11 PM-7AM on 04-08-19 and #5, #6, and #7 were scheduled to work the 11PM-7AM shift on 04-09-19. The schedule indicated staff #7 called out of work, but did not indicate the staff who substituted for staff #7. 2. Staff time sheets reviewed with staff #1 and staff #2, indicated that two staff (staff #5 and #6 ) clocked in to work the 11PM- 7 AM shift on 04-09-2019. Staff #1 and #2 were not able to provide documentation to indicate which staff member worked the memory care unit on 04-09-2019. 3. Review of the resident census list with staff #1 revealed there were 21 residents in care in the memory care unit on 04-09-19, which would require 3 staff on duty at all times.
Plan of Correction:	Staff work schedules are maintained per regulations. The staff attendance tracking is monitored and addressed weekly according to policy. Staff assignment sheets will be utilized with staff signing specific assignments to ensure staffing is per regulations. Audits will be submitted to the monthly Quality Assurance Committee. Person(s) responsible for implementing each step and/or monitoring any preventative measures: Wellness Director or her designee.
Standard #:	22VAC40-73-660-A-1
Complaint related:	No
Description:	Based on observation and interview, the facility failed to ensure the medication storage area was locked. Evidence: 1. On 06-25-2019 with staff #2, Licensing Inspector (LI) observed the medication cart on the first floor hallway across from the nursing office and memory care unit. The medication cart was unlocked and unattended at approximately 11:30 AM. LI opened the two top drawers to confirm the cart was unlocked. Staff #2 opened the nursing office's door and identified staff #3 as the Registered Medication Aide (RMA) assigned to the cart. Staff #3 stated she did not have any medications to administer at the time. 2. LI brought the unlocked medication cart to the attention of staff #3 who acknowledged the cart was unlocked.
Plan of Correction:	The medication cart is locked. Staff #3 received disciplinary action for leaving the medication cart unlocked and unattended. In addition, staff will be in-serviced ensuring medication storage areas are locked. Random audits of the medication carts will be done three times weekly for 30 days, then weekly for two months. Audits will be submitted to the monthly Quality Assurances Committee. Person(s) responsible for implementing each step and/or monitoring any preventative measures: Wellness Director or Assistant Resident Care Director.
Standard #:	22VAC40-73-680-D
Complaint related:	Yes
Description:	Based on record review and interview, the facility failed to ensure medications were administered in accordance with the physician's or other prescriber's instructions. Evidence: 1. During review of resident #3's record, Licensing Inspector observed a fax communication dated 04-09-2019 from the facility to resident's physician informing that the pharmacy identified a medication interaction between two medications, Wellbutrin SR 100mg and Rasagiline Mesylate 0.5mg, therefore one must be discontinued. The record contained a physician's order to discontinue Aziletec (Rasagiline Mesylate) 0.5mg dated 04-10-2019. Review of the April 2019 Medication Administration Record (MAR) revealed the facility continued to administer the Rasagline Mesylate 0.5mg for 5 days, from 04-11-2019 through 04-15-2019. 2. During interview, staff #2 acknowledged the Rasagiline Mesylate for resident #3 was discontinued on 4-10-2019 and that the documentation on the MAR indicated the medication was administered until 04-15-2019. 3. During review of resident #2's record, the resident was readmitted to the facility from rehab on 05-15-2019. Resident #2's physician's orders dated 05-14-2019 indicated to administer Amlodipine 5mg one tab daily "hold and call MD if SBP [systolic blood pressure] is less than 50", and an order to administer Diazepam 5mg 1/2 tab at bedtime "hold for sedation or SBP [systolic blood pressure] less than 100". Review of the May 2019 MAR did not document whether resident #3's blood pressure was taken to determine if the blood pressure was below 50 for the Amlodipine or below 100 for the Diazepam from 05-15-2019 through 05-30-2019. 4. LI interviewed staff #2 who acknowledged the MAR did not indicate if the resident's blood pressure was taken. Staff #2 was unable to provide documentation to indicate that staff obtained resident #2's blood pressure to determine if the medication should be held in accordance with the physician's order.
Plan of Correction:	"This plan of correction is submitted as required under State and Federal law. The submission of this Plan of Correction does not constitute an admission on the part of Waterford at Virginia Beach as to the accuracy of the surveyors' findings or the conclusions drawn therefrom. Submission of this Plan of Correction also does not constitute an admission that the findings constitute a deficiency or that the scope and severity regarding the deficiency cited are correctly applied. Any changes to the Community's policies and procedures should be considered subsequent remedial measures as that concept is employed in Rule 407 of the Federal Rules of Evidence an any corresponding state rules of civil procedure and should be inadmissible in any proceeding on that basis. The Community submits this plan of correction with the intention that it be inadmissible by any third party in any civil or criminal action against the Community or any employee, agent, officer, director, attorney, or shareholder of the Community or affiliated companies." Resident #3 Rasagline Mesylate was discontinued. Resident #2 blood pressure is being taken prior to the administration of Amlodipine to determine if the blood pressure is less than 50. Bi-weekly reports will be obtained from the pharmacy on discontinued medications and checked against the Medication Administration Report for accuracy. A complete audit of all residents on blood pressure medication, with perimeters, was conducted on July15, 2019. Weekly audits of perimeters will be completed and submitted to the Monthly Quality Assurance Committee. Person(s) responsible for implementing each step and/or monitoring any preventative measures: Wellness Director, Memory Care Director or lead Registered Medication Aid.