VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Harmony at Oakbrooke
301 Clearfield Avenue
Chesapeake, VA 23320
(757) 315-6900

Current Inspector: Alyshia E Walker (757) 670-0504

Inspection Date: Nov. 6, 2020 , Nov. 9, 2020 , Nov. 13, 2020 , Dec. 1, 2020 and Dec. 2, 2020

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 EMERGENCY PREPAREDNESS 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS Article 1 Subjectivity

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 11-06-2020 and concluded on 12-02-2020. The Administrator was contacted by telephone to initiate the inspection. The Administrator reported that the current census was 68. The inspector emailed the Administrator a list of items required to complete the inspection. The inspector reviewed 4 resident records, 4 staff records, criminal background checks and sworn disclosures of newly hired staff, staff schedules, fire drills, fire and health inspection reports, and healthcare oversight. Information gathered during the inspection determined non-compliances with applicable standards or law, and violations were documented on the violation notice issued to the facility.

Violations:

Standard #:	22VAC40-73-680-D
Description:	Based on record review and interview, the facility failed to ensure medications are administered in accordance with the physician's instructions and are consistent with the standards of practice outlined in the current registered medication aide curriculum approved by the Virginia Board of Nursing. Evidence: 1. Resident #1?s current signed physician?s orders dated 08-25-2020 documented ?Haloperidol Lac 2 MG/ML- Take 1ML (=2MG) by mouth/under tongue every 4 hours as needed for agitation.? 2. Resident #1?s October 2020 Medication Administration Record documented: a. Staff #6, a Registered Medication Aide (RMA), administered Haloperidol Lac 2MG/ML for ?Pain in legs? on 10-04-2020 at 1:24 AM; b. Staff #7, a Licensed Practical Nurse, administered Haloperidol Lac 2MG/ML for ?Anxiety? on 10-10-2020 at 1:33 AM and for ?SOB? on 10-13-2020 at 4:04 PM; and c. Staff #8, a RMA, administered Haloperidol Lac 2MG/ML for ?Anxiety? on 10-20-2020 at 9:17 AM. 3. Staff #1 provided a copy of resident #1?s ?Narrative Charting? [nursing notes] and the facility?s 24-hour communication log for 10-04-2020, 10-10-2020, 10-13-2020 and 10-20-2020. There was no documentation indicating that the resident was agitated on those dates. Staff #1 could not provide documentation verifying resident #1 was agitated on the aforementioned dates. 4. Staff #8 was asked why Haloperidol 2MG/ML was administered to resident #1 for ?Anxiety? on 10-20-2020 at 9:17 AM, and staff #8 stated ?I do not recall the incident on 10-20-2020.? 5. Staff #7 was asked why Haloperidol 2MG/ML was administered to resident #1 for ?Anxiety? on 10-10-2020 at 1:33 AM, and for ?SOB? on 10-13-2020 at 6:04 PM, and staff #7 stated ?If that is what I wrote down, that is what it was administered for.? 6. Staff #1 acknowledged resident #1?s PRN Haloperidol Lac 2MG/ML was not administered in accordance with the physician?s instructions.
Plan of Correction:	Executive Director reviewed with Nurse Practitioner (NP) Resident #l's medication list. NP clarified signs and symptoms for PRN medication. Health Care Director/Designee will complete a training with staff #7 & #8 on appropriate administration of PRN medication based on reason.