VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Dominion Village of Williamsburg
4132 Longhill Road
Williamsburg, VA 23188
(757) 258-3444

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

Inspection Date: June 23, 2023

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-80 COMPLAINT INVESTIGATION

Violations:

Standard #:	22VAC40-73-640-A
Complaint related:	No
Description:	Based on record review, the facility failed to implement its written plan for medication management, specifically regarding methods to ensure that each resident?s prescription medications and over-the counter drugs and supplements ordered for the resident are filled and refilled in a timely manner to avoid missed dosages. Evidence: 1. The facility?s Medication Management Plan states that, ?Nurses and RMA?s shall be responsible for the timely ordering, and re-ordering of medications so that there are no missed doses or interruptions in the medications being administered. ? The policy further states, ?If a medication is not available to administer for any reason, the nurse/RMA will contact the physician to inform of when the medication will be made available and seek further instruction. The physician?s instructions will be documented on the (E) MAR.? 2. Resident # 1 has a physician?s order for Warfarin Sodium 6 mg tablet to be administered 1 tablet by mouth weekly every Saturday and Sunday. A review of the June 2023 MAR, notes the medication was not available on 6/3/23, 6/4/23, and 6/10/23. 3. Resident # 2 has a physician?s order for Albuterol Sulfate to be administered via nebulizer every 12 hours. A review of the June MAR notes the medication was not available to be administered on: 6/16/23 at 9:00 am, 6/16/23 at 9:00 pm, 6/17/23 9:00 am, 6/17/23 9:00 pm, 6/18/23 9:00 am ?Refused- however medication was not available?, 6/18/23 9:00 pm, 6/19/23 9:00 am, and 6/22/23 9:00 pm. 4. Resident # 3 has a physician?s order for Aspirin 81 mg to be taken 1 tablet every day. The April 2023 MAR notes the medication was not available to be administered on 4/14/23, 4/15/23, and 4/19/23. 5. Resident # 3 has a physician?s order for Atorvastatin Calcium 80 mg, 1 tablet at bedtime. The April 2023 MAR notes the medication was not available to be administered on 4/14/23, 4/18/23, 4/19/23, 4/20/23, 4/21/23, 4/22/23, 4/23/23, 4/24/23, and 4/26/23. 6. Resident # 3 has a physician?s order for Clonazepam 0.25 mg, 1 tablet three times a day. The April 2023 MAR notes the medication was not available to be administered on 4/14/23 8:00 am, 4/24/23 12:00 pm, 4/24/23 5:00 pm, 4/25/23 8:00 am, 4/25/23 12:00 pm, 4/25/23 5:00 pm, 4/26/23 8:00 am, 4/26/23 12:00 pm, 4/26/23 5:00 pm, 4/27/23 8:00 am, 4/27/23 12:00 pm. 7. Resident # 3 has a physician?s order for Clopidogrel F/C 75 mg, 1 tablet daily. The April 2023 MAR notes the medication was not available to be administered on 4/14/23, 4/23/23, 4/24/23, 4/25/23, 4/26/23, and 4/27/23. 8. Resident # 3 has a physician?s order for Ferretts 325 mg, 1 tablet by mouth daily. The April 2023 MAR notes the medication was not available to be administered on 4/14/23, 4/15/23, 4/19/23, 4/20/23, 4/21/23, 4/24/23, 4/25/23, 4/26/23, and 4/27/23. 9. Staff members #1 and #2 acknowledged the facility?s medication Management Plan was not followed.
Plan of Correction:	Health and Wellness Director made several attempts via fax, phone, and personal visits to the doctor?s office in order to get prescription refills. The refill prescriptions arrived by fax on April 28, 2023 and were filled by the pharmacy the same day. Every Monday and Thursday the Resident Care Coordinator goes through the medication cart and calls the pharmacy to refill any medications running low. On August 9, 2023 Omnicare gave us access to Omniview which allows the Health and Wellness Director and the Resident Care Coordinator to see which medications will be coming due for refill. This will eliminate last-minute refills and allow the pharmacy time to deliver the medications. As of June, 06, 2023 the resident using FNP who visits our residents weekly to ensure better communication between care staff and medical provider and timely responses to medication requests.