VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Traway Assisted Living Home AKA Synergy Community Supports, LLC
8001 Traway Court
Chesterfield, VA 23235
(804) 938-0667

Current Inspector: Yvonne Randolph (804) 662-7454

Inspection Date: April 20, 2021

Complaint Related: No

Areas Reviewed:

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 EMERGENCY PREPAREDNESS

Comments:

This inspection was conducted by licensing staff using an alternate remote protocol necessary due to a state of emergency health pandemic declared by the Governor of Virginia. A renewal inspection was initiated on 4/20/2021 and concluded on 4/21/2021. The administrator was contacted by telephone to initiate the inspection. The administrator reported that there were three residents in care. The inspector emailed the administrator a list of items required to complete the inspection. The inspector reviewed two (2) resident records, two (2) staff records, staff credentials, medication administration records, physician orders, fire inspection report, annual training, etc. submitted by the facility to determine compliance. Information gathered during the inspection determined non-compliance(s) with applicable standards or law, and violations were documented on the violation notice issued to the facility.

Violations:

Standard #:	22VAC40-73-310-A
Description:	Based on a review of two uniform assessment instruments, one resident was admitted who requires a level of care for which the facility is not licensed. Evidence: Resident # 1 is assessed on the uniform assessment instrument (dated 5/1/2021) as needing assisted living level of care. The facility is licensed for Residential Only care.
Plan of Correction:	UAI for Resident #1 contained typographical errors and resident certified by physician on admission for residential care and new UAI completed without error. (See new UAIs) Plan of action In-service all staff on UAI documents. Quarterly Review of all documentation ensuring accuracy.
Standard #:	22VAC40-73-310-H
Description:	Based on a review of two residents physical examinations, In accordance with ? 63.2-1805 D of the Code of Virginia, one resident was admitted with prohibited care needs: Evidence: The physical examination for resident # 1 dated 4/1/2021 document that resident # 1 requires continuous licensed nursing care. which is a prohibited care need for admission to a licensed assisted living facility
Plan of Correction:	Medical doctor updated physical examination reflecting admission of the resident does not require continuous licensed nursing care. Updated 4/28/21 (see attached form) Plan of action In-service staff on review on Medical physical exams.Q uarterly review of all documentation to ensure accuracy.
Standard #:	22VAC40-73-440-A
Description:	Based on a review of uniform assessment instruments for two residents, one resident was not assessed using the uniform assessment instrument (UAI) in accordance with Assessment in Assisted Living Facilities (22VAC30-110). Evidence 1.22VAC30-110 states "the assessment shall include sections related to identification and background, functional status...." The functional status was not documented on the uniform assessment instrument for resident # 1 dated 4/6/2021 in the areas of bathing, dressing, toileting, transferring, walking, wheeling, and mobility. 2. 22VAC30-110-20 states "the administrator or the administrator's designated representative shall approve and sign the completed UAI for private pay individuals". The UAI for resident # 1 dated 4/6/2021 had no signature in the section of the UAI where the administrator or the administrator's representative would approve and sign. The UAI dated 4/6/2021 for resident # 1 does not accurately describe the identified needs of the resident based on the admission physical examination. The UAI for resident # 1 dated 4/6/2021 documents medication administration without assistance. The physical examination completed at admission and dated 4/1/21 documents that the resident is not capable of self-administering medication.
Plan of Correction:	UAI assessment correctly completed by licensed UAI personnel on 5/7/21. Please see attached) Administrator signature also completed on UAI 5/7/21 (Please see attached sheet) See updated physical and updated UAI (Match) (Updated medication form reflects self-medication)
Standard #:	22VAC40-73-450-C
Description:	Based on a review of the individualized service plan for two residents, the plans do not address the time frame for expected outcome. Evidence: The section to document time frame for expected outcome was not completed on the individualized service plans submitted by the facility for residents # 1 and # 2
Plan of Correction:	Updated Individualized plan (ISP) completed with timeframes documented. (See attached forms) Plan of action In-service staff on ISP and documentation. Quarterly review of all documentation to ensure accuracy.
Standard #:	22VAC40-73-550-F
Description:	Based on a review of the rights and responsibilities document for two residents, the form did not include all required information. Evidence: The rights and responsibilities document for resident # 1 submitted for review by the facility did not include the name and telephone number of the Regional Licensing Administrator or the local ombudsman serving the area in which the facility is located.
Plan of Correction:	Updated Residents Rights with phone numbers included for the Regional Licensing Administrator or the local ombudsmen serving the area (see updated form) Plan of action In-service staff on and documentation and Resident Rights.Q uarterly review of all forms and documentation to ensure accuracy.
Standard #:	22VAC40-73-670-1
Description:	Based on a review of medication administration records for two residents, each staff person who administers medication is not authorized by ? 54.1-3408 of the Virginia Drug Control Act. Evidence: 1. Staff # 3 documented (by initials) the administration of eleven medications (metoprolol, atorvastatin calcium, latanoprost ophthalmic solution, aspirin, vitamin D3, levetiracetam, lacosamide, guaifenesin, albuterol sulfate, symbicort, fluticasone propionate) to resident # 2. Staff # 3 is not licensed by the Commonwealth of Virginia to administer medications or registered with the Virginia Board of Nursing as a medication aide. 2. Staff # 1 documented (by initials) the administration of nine medications (hydrochlorothiazide, melformin, eliquis, potassium EL, gabupentin, vitamin D3, omeprazole, lostartan) to resident # 1. Staff # 3 is not licensed by the Commonwealth of Virginia to administer medications or registered with the Virginia Board of Nursing as a medication aide.
Plan of Correction:	Staff #1 and #3 by initials not licensed to administer medications. The MAR form is for documentation supervision of self-medications only. No staff is giving residents medication at the Traway Assisted living Home. The residents are all self-medication and only monitored daily that the medications are taken. No MAR is an official document only a tool for reporting signatures on MAR form only signify that the resident was observed taking medications on the date. Plan of action Quarterly Review of all documentation ensuring accuracy. In-service all staff on MAR self-medication recording.