VIRGINIA DEPARTMENT OF SOCIAL SERVICES

The Harmony Collection at Roanoke Assisted Living
4402 Pheasant Ridge Road
Roanoke, VA 24014
(540) 970-3524

Current Inspector: Holly Copeland (540) 309-5982

Inspection Date: June 11, 2024

Complaint Related: No

Areas Reviewed:

22VAC40-73 RESIDENT CARE AND RELATED SERVICES

Comments:

Type of inspection: Monitoring Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 06/11/2024 from 11:00 AM until 02:00 PM The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. A self-reported incident was received by VDSS Division of Licensing on 05/14/2024 regarding allegations in the area(s) of: Resident care and related services. Number of residents present at the facility at the beginning of the inspection: 90 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 1 Number of staff records reviewed: 0 Number of interviews conducted with residents: 0 Number of interviews conducted with staff: 2 Observations by licensing inspector: N/A Additional Comments/Discussion: N/A An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation supported the self-report of non-compliance with standard(s) or law, and violation(s) were issued. Any violation(s) not related to the self-report but identified during the course of the investigation can also be found on the violation notice. The licensee has the opportunity to submit a plan of correction to indicate how the cited violation(s) will be addressed in order to return the facility to compliance and maintain future compliance with applicable standard(s) or law. If the licensee wishes to provide a plan of correction: (i) type the plan on a separate Word document, (ii) identify the standard violation number being addressed, (iii) include the date the violation will be corrected, (IV) do not include any names or confidential information, and (V) return to the licensing inspector by email within five (5) business days of the exit interview. Compliance with all applicable regulations and law shall be maintained and any areas of noncompliance must be corrected. Within 15 calendar days of your receipt of the inspection findings (inspection summary, violation notice, and supplemental information), you may request a review and discussion of these findings with the inspector's immediate supervisor. To make a request for review and discussion, you must contact the licensing supervisor at the regional licensing office that serves your geographical area. Regardless of whether a supervisory review has been requested, the results of the inspection will be posted to the DSS public website within 5 business days of your receipt of the Inspection Summary and/ or Violation Notice. The department's inspection findings are subject to public disclosure. Please Note: A copy of the findings of the most recent inspection are required to be posted on the premises of the facility. For more information about the VDSS Licensing Programs, please visit: www.dss.virginia.gov Should you have any questions, please contact Holly Copeland, Licensing Inspector at 540-309-5982 or by email at holly.copeland@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-680-D
Description:	Based on record review and staff interview, the facility failed to ensure that medications are administered according to physician or other prescriber?s orders. EVIDENCE: 1. The record for resident 1 indicated that the resident was initially admitted to the assisted living facility (ALF) on 10/23/2022. The record also contained skilled nursing facility (SNF) discharge documentation which indicates that resident 1 had been admitted to a SNF on 04/03/2024 and was to be discharged back to the ALF around 05/03/2024. 2. On 05/14/2024, LI received a facility reported incident (FRI), dated 05/14/2024, which indicated that resident 1 was not administered the following medications by the ALF for four days due to pharmacy error and failure to send the medication following receipt of a new history and physical: Aripiprazole 2mg, 1 tab PO QD for mood; Aspirin 81mg, 1 tab PO QD for heart health; Plavix 75mg, 1 tab PO QD for Stroke Prevention; Pantoprazole Sodium DR 20mg, 1 tab PO QD for GERD; Rosuvastatin -Calcium 10mg, 1 tab PO QD for cholesterol. 3. An interview with staff 2, which occurred on 06/11/2024, revealed that resident 1 returned to the assisted living facility from the skilled nursing facility on the afternoon of 05/10/2024. Staff 2 clarified that the reported missed doses of medication occurred between resident 1?s return to the ALF date of 05/10/2024 and the date of the facility?s report to LI on 05/14/2024. 4. The REPORT OF RESIDENT PHYSICAL EXAMINATION (H&P) completed prior to resident 1?s readmission to the ALF, signed 04/30/2024, contained orders for the following medications to be administered ongoing at that time: Rosuvastatin Calcium Oral Tablet 10mg, 1 tab by mouth one time a day for hyperlipidemia; Clopidogrel Bisulfate Oral Tablet 75mg, 1 tab by mouth one time a day related to atherosclerosis of coronary artery bypass grafts unspecified, with unspecified angina pectoris. Pantoprazole Sodium Oral Tablet Delayed Release 20mg, 1 tab by mouth one time a day for GERD; Midodrine HCl Oral Tablet 5mg, 1 tab by mouth three times a day for orthostatic hypotension; Aspirin EC Low Dose Oral Tablet Delayed Release 81mg, 1 tab by mouth one time a day for prophylaxis; Loperamide HCl Oral Tablet 2 mg, 1 tab by mouth as needed for diarrhea daily as needed (PRN); Acetaminophen Extra Strength Oral Tablet 500mg, 1 tab by mouth every 6 hours as needed for pain (PRN). (See attached page for remainder of evidence)
Plan of Correction:	Medication refresher course has taken place 7-9-24 for current staff. Healthcare Director or designee will be responsible for a 10% audit of the MAR will be completed each day looking for omissions and pharmacy errors.
Standard #:	22VAC40-73-680-E
Description:	Based on record review and staff interview, the facility failed to ensure that medical procedures or treatments ordered by a physician or other prescriber shall be provided according to his instructions and documented. EVIDENCE: 1. Based on the updated H&P, signed on 04/30, resident 1 had current orders for the following treatments: Budesonide 0.5 MG/2 ML suspension, Inhale 1 vial through nebulizer every 12 hours for shortness of breath; Ipratropium Albuterol Inhalation Solution 0.5-2.5 (3) mg/mL, Inhale 3 mL orally every 6 hours as needed for wheezing. 2. The May 2024 MAR for resident 1 indicated that the scheduled Budesonide 0.5 mg/2 mL suspension was not administered on the following dates and times: 05/11 at 08:00 AM; 05/12 at 08:00 AM and 08:00 PM; and 05/13 and 05/14 at 08:00 AM, all indicating the dose was missed due to waiting on pharmacy.
Plan of Correction:	Medication refresher course has taken place 7-9-24 for current staff. Healthcare Director or designee will be responsible for a 10% audit of the MAR will be completed each day looking for omissions and pharmacy errors.