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: No

Areas Reviewed:

22VAC40-73 ADMISSION, RETENTION, AND DISCHARGE OF RESIDENTS 22VAC40-73 BUILDING AND GROUNDS

Comments:

This was an unannounced focused monitoring inspection conducted to follow-up on violations cited during a previous inspection. The inspection was conducted by two licensing inspectors from the Eastern Regional Office on May 29, 2019 from 7:56 AM until 2:58 PM and on May 30, 2019 from 12:51PM until 4:31 PM. There were 53 residents in care. During the inspection, resident and staff records were reviewed, with a focus on staff training and initial orientation to the facility upon hire. Criminal background checks were reviewed for new staff since the previous inspection. Staff schedules were also reviewed. A medication observation was conducted, as well as a review of physician's orders and Medication Administration Records (MARs). 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. The plan of correction should include: 1. Steps to correct the non-compliance 2. Measures 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 #:	22VAC40-73-310-H
Description:	Based on record review and interview, the facility failed to ensure it did not retain individuals with psychotropic medications without an appropriate treatment plan. Evidence: 1. During review of resident #5's record, resident #5 was admitted on 05-23-2019 with physician's orders for Risperidone for psychosis, Divalproex for mood, and Risperidal for psychosis. The resident's record did not contain a psychotropic treatment plan for the aforementioned medications. 2. During interview, staff #1 acknowledged resident #5 did not have a treatment plan in the record.
Plan of Correction:	Psychotropic treatment plans will now be filled out initially by the doctor from the [admitting] hospital. They will be included with the TB and H&P prior to admission. If they need to be updated after admission WTCSB Psychiatrist will be responsible for doing this.
Standard #:	22VAC40-73-860-I
Description:	Based on observation and interview, the facility failed to ensure cleaning supplies and other hazardous materials were stored in a locked area. Evidence: 1. On 5-29-2019, Licensing Inspectors observed an unattended cleaning cart, opened and unlocked in the hallway near "Office two". The cart contained Odoban, Glade spray, Lysol disinfecting wipes, Lysol spray, Windex glass cleaner, as well as Pinesol floor cleaner in a clear spray bottle, and bleach in a clear labeled spray bottle. 2. Staff #2 observed the unlocked cart in the hallway and stated it belonged to staff #3. Staff #2 acknowledged and identified the cleaning supplies mentioned.
Plan of Correction:	All housekeeping staff have been instructed that housekeeping carts must be closed and locked at all times when out of the storage closet. Cart that would not lock has been removed from service and a new cart purchased.