VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Morningside of Bellgrade
2800 Polo Parkway
Midlothian, VA 23113
(804) 379-2800

Current Inspector: Tamara Watkins (804) 662-7422

Inspection Date: Feb. 2, 2022

Complaint Related: No

Areas Reviewed:

22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES 22VAC40-73 RESIDENT CARE AND RELATED SERVICES

Comments:

A focused monitoring inspection was conducted February 2, 2022 to follow up on previously cited violations regarding concerns in the areas of resident care and related services. The Administrator and Director of Nursing were present onsite during the inspection. Resident medication records and policies/procedures were reviewed. An exit interview was conducted onsite, and additional information was reviewed February 3, 2022 remotely in regards to resident medications and COVID protocols.

Violations:

Standard #:	22VAC40-73-100-A
Description:	Based on record review and interview with staff, the facility failed to ensure the assisted living facility implemented their infection control program addressing the surveillance, prevention, and control of disease and infection that is consistent with the federal Centers for Disease Control and Prevention (CDC) guidelines. Evidence: 1. Staff #1?s mask was pulled down below the chin and not covering Staff #1?s nose or mouth on 2-02-2022 during inspection. 2. Additionally, Staff #2 was sweeping in the lobby of the building had a face mask pulled down below the staff?s nose and mouth below the chin while residents and other staff were present. 3. The facility?s ?COVID-19 Infection Control Mitigation Plan? dated 9-03-2020 documented under ?3. PERSONAL PROTECTIVE EQUIPMENT (PPE)???All community personnel are wearing a facemask while in the facility.? Additionally, under ?1. SCREENING, TESTING AND COHORTING??? The community will monitor CDC [Centers for Disease Control and Prevention] guidance and modify these procedures to remain consistent with the most current guidance on an ongoing basis.? 4. The CDC website updated 2-2-2022 under ?Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic? read, ?Implement Source Control Measures ?Source control refers to use of respirators or well-fitting facemasks or cloth masks to cover a person?s mouth and nose to prevent spread of respiratory secretions when they are breathing, talking, sneezing, or coughing.? 5. Staff #3 acknowledged during interview that the aforementioned staff were not following the facility?s COVID-19 Infection Control Mitigation Plan.
Plan of Correction:	Full review and requirements for mask wearing, and precautionary steps taken to prevent the spread of Covid. Mask wearing, use of PPE, cleaning and resident guidance will be reviewed. TBC
Standard #:	22VAC40-73-650-E
Description:	Based on record review and interview with staff, the facility failed to ensure the resident's record contained the physician's signed written order or a dated notation of the physician's or other prescriber's oral order. Evidence: 1. Licensing inspector requested the following physician?s signed written orders or oral order for residents? record review: a. Resident #1: Aspirin 81 mg, Atorvastatin 20 mg, Boost Breeze 0.4G-1.05 Liquid, Calcium Carbonate 600 mg, Clopidogrel F/C 75 mg, Docusate Sodium Softgel 100 mg, Famotidine F/C 20 mg, Ferrous Gluconate 324 mg, Metoprolol Succinate ER 50 mg, Midodrine HCL 2.5 mg, Mycophenolate Mofetil F/c 500 mg, Namzaric 28 mg-10 mg, Ocuvite 1000-60, Vitamin D3 400u, Levemir 100U/1ML, Novolog Flexpen 100/ML (Bedtime As Needed) and Novolog Flexpen (sliding scale) ; and b. Resident #2: Alfuzosin HCL ER F/C 10 mg, Amlodipine Besylate 10 mg, Carbidopa-Levodopa 25 mg ? 100 mg, Divalproex Sodium ER 500 mg, Docusate Sodium 100 mg, Dutasteride 0.5 mg, Hydralazine HCL 25 mg, Losartan Potassium F/c 25 mg, Metoprolol Succinate 100 mg, Preservision AREDS 250-5 mg, Quetiapine Fumarate ER 200 mg, Quetiapine Fumarate F/c 25 mg, Linzness 72 mcg (as needed), Polyethylene Glycol 3350 (as needed). 2. Staff #4 confirmed the facility failed to ensure Resident #1 and Resident #2?s records contained the physician's orders of the medications the residents were taking per the January 2022 Medication Administration Record (MAR).
Plan of Correction:	All orders (written or Oral) received into the community will be viewed and verified by Nursing Director before filling to verify all appropriate information, pt name, physician signature, order date, RX, TX, and DX. Order will be transcribe onto the current MAR, then placed in the resident file. ED will verify each file is complete. Completed.
Standard #:	22VAC40-73-680-D
Description:	Based on the review of resident records, the facility failed to administer medications in accordance with the physician's or other prescriber's instructions and consistent with standards of practice outlined in the current registered medication aide curriculum approved by the Virginia Board of Nursing. Evidence: 1. Commonwealth of Virginia Board of Nursing Medication aide Curriculum for Registered Medication Aides, Revised May 21, 2013 states: a. Chapter 5, Section 5.1 titled, "5.1 Describe Three Types of Forms Commonly Used to Document Medication Administration" states, Documentation is an important part of medication management. It is frequently referred to as the "6th Right" of medication administration". b. Section 5.3. titled "Document Medication Administration on the Medication Administration Record [MAR] states, "All medications administered or omitted" under "What to Document". 2. Resident #1 and Resident #2?s January 2022 MARs had no documentation of medication administration or omission on the following medications at the following dates and times: A. Resident #1: a. Aspirin, Atorvastatin, Boost, Calcium Carbonate, and Midodrine on 1-01-2022 at 8:00 a.m.; b. Boost 1-17-2022 and 1-31-2022 at 8:00 p.m.; c. Vitamin D3 1-21-2022 at 8:00 a.m.; d. Levemir 1-07-2022, 1-10-2022, 1-13-2022, 1-15-2022, 1-21-2022 at 8:00 p.m.; e. Namzaric (circled initials with no comment) 1-19-2022 at 8:00 a.m. B. Resident #2: a. Amlodipine Besylate 1-15-2022 at 8:00 a.m.; b. Carbidopa-Levodopa 25 mg ? 100 mg 1-08-22 at 4:00 p.m.; c. Divalproex Sodium, Docusate Sodium, Dutasteride on 1-08-2022 at 8:00 p.m.; d. Divalproex Sodium 1-10-2022 at 8:00 p.m.; e. Hydralazine 1-08-2022 at 10 p.m. and 1-10-2022 at 2:00 p.m.; f. Losartan Potassium 1-15-2022 and 1-17-2022 at 8:00 a.m.; g. Metoprolol Succinate 1-15-2022 and 1-17-2022 at 8:00 a.m. h. Additionally, the following medications had circled initials with no comment: Amlodipine Besylate 1-16-2022 and 1-17-2022 at 8:00 a.m., Losartan Potassium 1-16-2022 at 8:00 a.m., and Metoprolol Succinate 1-16-2022 at 8:00 a.m. 3. Staff #4 confirmed the aforementioned documentation regarding the aforementioned dates and times medications were not documented as administered or omitted for Resident #1 and Resident #2.
Plan of Correction:	Training was held on 2/17/22 to review for all medication tech staff on proper documentation in the MAR, PRN meds, Not administered meds, with reason documentation. Additional training was supplied for those Med techs directly a fault for failure to document. Spot checking of MAR will continue to take place by the Director of Nursing and Executive Director.