VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Green Valley Manor
1011 Pennsylvania Avenue
Winchester, VA 22601
(540) 450-5642

Current Inspector: Sarah Pearson (540) 680-9469

Inspection Date: Nov. 26, 2019

Complaint Related: No

Areas Reviewed:

22VAC40-73 GENERAL PROVISIONS 22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES 22VAC40-73 PERSONNEL 22VAC40-73 STAFFING AND SUPERVISION 22VAC40-73 ADMISSION, RETENTION, AND DISCHARGE OF RESIDENTS 22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-73 RESIDENT ACCOMODATIONS AND RELATED PROVISIONS 22VAC40-73 BUILDING AND GROUNDS 22VAC40-73 EMERGENCY PREPAREDNESS 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS Article 1 Subjectivity 32.1 Reported by persons other than physicians 63.2 Protection of adults and reporting. 63.2 Facilities and Programs.. 22VAC40-90 Background Checks for Assisted Living Facilities 22VAC40-90 The Sworn Statement or Affirmation 22VAC40-90 The Criminal History Record Report

Technical Assistance:

1. Consider using DSS templates to document staff training and calculating hours; 2. Discussed new generation information requirements; 3. Reminder to document contacts when trying to secure UAIs from a third party; and 4. Send notification of medication refusals to physician and case managers as applicable. Census: 21 Two Inspectors 9am-3pm

Comments:

The information contained in this renewal inspection report will be reviewed by the licensing administrator. The facility will be notified by mail regarding their renewal status. Three violations were identified during this unannounced renewal inspection process. They were in the areas of service plan documentation, annual tuberculosis evaluations or screenings and medication administration documentation. Details can be found in the violations portion of this report. During the inspection the additional building on grounds was inspected to ensure that it was ready for the modification to be made to the current license allowing for an additional 16 residents. A certificate of occupancy had been received. Fire inspections were current for both buildings. The commercial kitchen is located in Building one and also had a current inspection. The health department will look at completing a courtesy inspection for building 2 since it will be used primarily to afford residents residing in that location to work on transition skills for moving to the community. All meals will be prepared in the commercial kitchen and transported to Building 2 as needed based on the weather. Other outside inspections were current. Fire and emergency drills and training were complete. Activities and menus were posted and observed as outlined. Medication administration witnessed appeared to meet Board of Nursing guidelines although not consistently reflected in the medication administration records as noted in the violation. Residents and families were highly complimentary of the care received at the facility. Thank you to residents, families and staff for your cooperation during this renewal inspection process. If you have additional questions or concerns please call (540) 332-2330 or e-mail this inspector at sharon.deboever@dss.virginia.gov.

Violations:

Standard #:	22VAC40-73-250-D
Description:	Based on a review of staff and resident records, initial and/or annual screenings were not consistently obtained.
Plan of Correction:	Initial and annual screenings as applicable have been scheduled. Those reviewed had been checked off in error as complete as opposed to scheduled.. The checklist will only be used in the future when copies of actual completion have been obtained with a notation of scheduled. All records will be reviewed to ensure there are no additional annual reviews missing. The administrator will be assisted by a designated staff to identify any additional needs and this information will be forwarded to the nurse for follow up. The administrator assumes responsibility for correction and future compliance.
Standard #:	22VAC40-73-450-C
Description:	Based on a review of a random sample of resident records and individualized service plans(ISP), the plans did not include the following: Resident A: Transfer and walking, wheeling and mobility skills, behaviors and medication administration not addressed. Resident B: Orientation and behavior not addressed - plan also not signed. Resident C: Mental health services not addressed. Resident H: Needs identified on the uniform assessment instrument (UAI) in the areas of eating, walking, wheeling and stair climbing do not match the needs addressed on the ISP.
Plan of Correction:	UAIs and ISPs for all individuals will be reviewed by the administrator, assistance and facility nurse to ensure corrections are made and future compliance is met. An additional staff person is being reviewed to participate in the ISP training to further assist with this process and maintaining compliance.
Standard #:	22VAC40-73-680-D
Description:	Based on review of a random sample of medication administration records medication was not consistently administered as per physician orders or consistent with standards of practice in the current registered medication aide curriculum as approved by the Virginia Board of Nursing, particularly as it relates to documentation. Resident A has two medications for agitation with no designation which should be tried first and based on documentation were on at least five occasions given at the same time. Resident A also has multiple refusals of medication or noted as "physically unable to take" with no documentation that physician was notified. Resident B receives medication as needed for pain - documentation indicates medication did not work and no indication there was follow up with physician to resolve the issue. Resident C has no parameters regarding when to call physician as it relates to blood glucose levels that may be too high, only those that are low. Medication review indicates that medication resident is receiving could increase blood glucose levels and needs a physician response. Resident D has medication to assist with sleep. Results indicate on three occasions it did not work with no follow up with physician as to how to respond. It would also appear to be used in response to anxiety which is not part of the diagnosed use. There are also multiple occasions throughout the month where the medication is documented as being refused or not available with no follow up noted with pharmacy or physician. Resident E has medication requiring blood pressure and pulse prior to administration. There is no documentation of pulse. Resident also refused portion of scheduled medication on at least 8 different days between November 1 and November 24 with no documentation of follow up with physician. Blanks were also noted where there should have been initials to indicate medication was administered. A review of the cards and count indicated it was administered but not documented.
Plan of Correction:	All medication aides will receive a refresher course as it relates to the aforementioned violations. The administrator or designated staff will review medication administration records a minimum of weekly to ensure consistency in documentation and administration. Orders will be clarified following review of all medication administration records. The administrator and facility nurse assume responsibility for correction and future compliance.