VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Tidewater Cove, Operated by Western Tidewater CSB
2536 East Washington Street
Suffolk, VA 23434
(757) 935-1415

Current Inspector: Margaret T Pittman (757) 641-0984

Inspection Date: May 29, 2019 and May 30, 2019

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES 22VAC40-73 RESIDENT CARE AND RELATED SERVICES

Comments:

This was an unannounced complaint inspection conducted by two Licensing Inspectors from the Eastern Regional Office. The inspection was conducted on May 29, 2019 from 7:56 AM until 2:58 PM and on May 30, 2019 from 12:51 PM until 4:31 PM. There were 53 residents in care. The complaint alleged concerns regarding medication administration and administration times, resident care, staffing, and facility not reporting incident reports. During the inspection a medication observation was conducted, resident interviews were also conducted. Resident records and staff schedules were reviewed. The following was discussed during the inspection: Monitoring diet orders to ensure accuracy, physician's orders for crushed medications, discussed Medication Administration Records (MARs) and staff signatures, incontinence care refusals, and ISPs. The facility received violations under Administration and Administrative Services and Resident Care and Related Services. The areas of non compliance were discussed with the Administrator throughout the inspection and during the exit interview. Based on the information gathered during this inspection the concerns regarding incident reports and medication administration were found to be valid. Please complete the "plan of correction" and "date to be corrected" for each violation cited on the violation notice. The 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. Steps 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 preventative actions. If you have any questions please contact your Licensing Inspector at 757-353-0430.

Violations:

Standard #:	22VAC40-73-100-C-1
Complaint related:	No
Description:	Based on observation and interview, the facility failed to ensure procedures for the implementation of infection measures by staff include means to ensure hand hygiene. Evidence: 1. During the medication pass observation with staff #2 on 05-29-2019 at 8:00 AM, Staff #2 failed to sanitize hands by means of hand washing or hand sanitizer and proceeded to administer medications to three residents without cleaning hands. 2. Staff #2 was observed picking up a Clonazepam pill from the top of the medication cart with bare hands, and placing back into a cup to administer to Resident #1. 3. Staff #2 acknowledged that hands were not sanitized between medication administration of each resident, and stated that staff sanitize ?whenever they can? during medication passes.
Plan of Correction:	All staff were reminded of infection control manual, medication management manual, and policy and procedures manual. They have been instructed to view the procedures for medication administration in all of these manuals. Healthcare Oversight RN also reinforced the proper procedure for hand sanitizing and the use of gloves during medication passes to include handling any medication and when to sanitize and when handwashing is required.
Standard #:	22VAC40-73-70-A
Complaint related:	Yes
Description:	Based on record review and interview, the facility failed to report to the regional licensing office within 24 hours any major incident that has negatively affected or that threatens the life, health, safety, or welfare of any resident. Evidence: 1. On 05-06-2019, an ALF Progress Note by staff #4 read that resident #4 reportedly became very aggressive to another resident. According to the ALF Progress note, resident #4 pushed resident #2 to the floor in the bathroom. Police were called out regarding incident. 2. A Clinical Shift Note created by staff #3 on 05-06-2019 at 6:00 ? 6:15 a.m. confirmed the details of the ALF Progress Note and that Resident #4 had been yelling, cursing, and had pushed Resident #2 onto the ground. Staff #3's note indicated police were at the facility at 6:20 a.m. that morning. 3. Staff #1 acknowledged the details in the note and failing to report to licensing with the details of the incident.
Plan of Correction:	Going forward Regional Licensing Office will be notified within 24 hours, whenever there is police presence at the facility. The administrator is responsible for this and in her absence a designee will be appointed.
Standard #:	22VAC40-73-450-E
Complaint related:	No
Description:	Based on record review and interview, the facility failed to ensure the Individualized Service Plan (ISP) was signed and dated by the resident or his legal representative. Evidence: 1. On 05-30-2019 during resident #3's record review, the current ISP dated 03-07-2019 was signed by the resident, however; not by the resident's legal appointed guardian. 2. Staff #1 confirmed there was no documentation confirming the guardian had received a copy or signed the ISP.
Plan of Correction:	All records have been reviewed for compliance. Documentation will be entered on ISP to indicate when it was sent to guardian for signature. When signed copy is returned it will be put in resident record. Administrator will continue to monitor compliance.
Standard #:	22VAC40-73-460-D
Complaint related:	No
Description:	Based on record review, the facility failed to provide supervision of resident schedules, care, and activities. Evidence: 1. During review of Resident #5's record, documentation of Nursing Notes on 04-28-2019 by staff #5 read: ?Was called to outdoor smoking area by clinician, resident was not responding as she normally does per clinician, it appeared that resident was overheated due to being outside for hours, attempted to get resident to stand so she could be brought back into building, resident was unable to walk, after getting her to stand we placed her in a wheelchair and brought her back into the building, resident was given water and cool compresses, 911 was called due to possible heat exhaustion/stroke?.? 2. An additional note on 04-28-2019 by staff #6 indicated she was informed resident #5 "didn't look herself" therefore the staff went to check on the resident. The note indicated that the resident's skin was "hot to touch". Per staff #6's note the resident's temperature was 101.8 and her blood pressure was 92/47. 3. Resident #5 was admitted to the hospital on 04-28-2019 for Altered Mental Status. 4. Staff #1acknowledged the documentation indicated resident #5 had been sitting outside for hours and could not indicate how the facility ensured the resident was supervised while outdoors prior to hospitalization.
Plan of Correction:	Courtyard will be monitored frequently while residents are outside by staff members. Hydration for residents who want to continue to be outside will be offered at this time. Any refusals to return to the building will be documented. (This particular resident was diagnosed with a UTI during her ER visit).
Standard #:	22VAC40-73-480-C
Complaint related:	No
Description:	Based on record review and interview, the facility failed to arrange specialized rehabilitative services by qualified personnel as needed by the resident, to include speech-language pathology services. Evidence: 1. During review of resident #1's record (admitted on 7-18-2019), the record contained a telephone order dated 07-22-2019 for a "speech eval & tx" (speech therapy to evaluate and treat) for a swallow evaluation. A Nursing note signed by Staff #7 on 07-23-2018 at 3:00 p.m. read: ?Client schedule with speech for swallowing evaluation Aug. 1...? 2. During interview, staff #1 was not able to provide documentation that the speech and swallow evaluation for resident #1 was completed, or documentation of the outcome of the evaluation.
Plan of Correction:	We will continue to make sure that all therapies and diagnostic tests will be scheduled as ordered. Charge nurse will follow-up to be sure all evaluations and test results are in the resident chart in a timely manner.
Standard #:	22VAC40-73-680-D
Complaint related:	Yes
Description:	Based on record review and observation, the facility failed to ensure that medications be administered in accordance with the physician?s or other?s prescriber?s instructions and consistent with the standards of practice outlined in the current registered medication aide curriculum approved by the Virginia Board of Nursing. Evidence: 1. On 05-29-2019, during the morning medication pass observation, staff #2 administered Clonazepam 0.25mg to Resident #1. Resident #1 was observed taking Clonazepam with water along with other pills, and swallowing them. Licensing Inspector (LI) also observed staff #2 administer Metoprolol Tartrate 25mg (1/2 tab) to resident #2. 2. During review of resident #1's record, the physician?s order dated 05-17-2019 for Clonazepam 0.25mg indicated ?Place on top of tongue where it will dissolve.? 3. Resident #2's physician?s order dated 04-12-2019 indicated resident is to receive a blood pressure check prior to receiving Metoprolol Tartrate Tab half tab of 25 mg at 8 AM as well as Metoprolol Tartrate Tab 25 mg at 9 PM. LI did not observe staff #2 obtain a blood pressure check prior to administering the Metoprolol to resident #2. 4. During interview, LI informed staff #1 of the observations during the medication pass. Staff #1acknowledged the physician's order for resident #1 instructed for the pill to be placed on tongue and not swallowed, and that resident # 2's physician's order instructed for a blood sugar reading to be obtained prior to administration of the Metoprolol.
Plan of Correction:	All RMA's have been retrained to include reading each and every medication order and administering medications per the physician orders. Complete vital signs when ordered prior to medication administration. Flow sheets have been put in the MAR book for vital signs that must be taken consistently. The frequency is designated on the flow sheet. Charge nurse and administrator will review MARS and flow sheets frequently for compliance.