VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Auburn Hill at Swift Creek
5800 Harbour Lane
Midlothian, VA 23112
(804) 250-5740

Current Inspector: Coy Stevenson (804) 972-4700

Inspection Date: July 15, 2022

Complaint Related: No

Areas Reviewed:

? 22VAC40-73 GENERAL PROVISIONS ? 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 ACCOMMODATIONS AND RELATED PROVISIONS ? 22VAC40-73 BUILDINGS AND GROUND ? 22VAC40-73 EMERGENCY PREPAREDNESS ? 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS ? ARTICLE 1 ? SUBJECTIVITY ? 32.1 REPORTED BY PERSONS OTHER THAN PHYSICIANS ? 63.2 GENERAL PROVISIONS ? 63.2 PROTECTION OF ADULTS AND REPORTING ? 63.2 LICENSURE AND REGISTRATION PROCEDURES ? 63.2 FACILITIES AND PROGRAMS ? 22VAC40-90 BACKGROUND CHECKS FOR ASSISTED LIVING FACILITIES ? 22VAC40-90 THE SWORN STATEMENT OR AFFIRMATION ? 22VAC40-90 THE CRIMINAL HISTORY RECORD REPORT ? 22VAC40-80 THE LICENSE ? 22VAC40-80 THE LICENSING PROCESS ? 22VAC40-80 COMPLAINT INVESTIGATION ? 22VAC40-80 SANCTIONS

Technical Assistance:

Activity duration or time code for activities schedule

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: 7/15/2022, 8:49 a.m. ? 1:30 p.m. The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. Number of residents present at the facility at the beginning of the inspection: 83 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 10 Number of staff records reviewed: 3 Number of interviews conducted with staff: 2 Observations by licensing inspector: meal, medication pass, activity, calendars Additional Comments/Discussion: N/A An exit meeting will be conducted to review the inspection findings. The evidence gathered during the inspection determined non-compliance with applicable standard(s) or law, and violation(s) were documented on the violation notice issued to the facility. 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 Alexandra Poulter, Licensing Inspector at (804)662-9771 or by email at alex.poulter@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-70-A
Description:	Based on record review and interview with staff, the facility failed to report to the regional licensing office within 24 hours any major incident that has negatively affected or that threatens the life, health, safety, or welfare of any resident. Evidence: 1. During inspection on 7-15-2022, Resident #5?s record documented Progress Notes on 7-12-2022 that the resident was Covid-19 positive; however, licensing was not notified of the positive Covid-19 resident. 2. An additional eight residents had not been reported within 24 hours to the licensing office between 7-05-2022 and 7-13-2022 per the list provided by Staff #1 via email on 7-17-2022.
Plan of Correction:	No negative outcome occurred as a result of this practice The community has communicated all cases of COVID timely to the department of health, residents, families, and employees. The DSS inspector has been notified of all current COVID positive cases in the community since the inspection. The ED or designee will communicate COVID positive cases to the DSS inspector coinciding with notification to the department of health, residents, families and employees.
Standard #:	22VAC40-73-650-B
Description:	Based on record review, the facility failed to ensure physician or other prescriber orders identified the diagnosis, condition, or specific indications for administering each drug. Evidence: 1. Resident #13?s physician?s orders signed 7-18-2022 did not identify the diagnosis, condition, or specific indications for the following medications: Anoro Ellipta 62.5 mcg/25 mcg, Mucinex 600+30 mg, Prednisone 20 mg, Polyethylene Glycol 3350 17 g, and Lorazepam 0.5 mg. 2. Staff #1 confirmed during review that the aforementioned was not documented on Resident #13?s physician?s orders.
Plan of Correction:	No negative outcome occurred as a result of this practice. Resident #13?s physicians orders were reviewed, and diagnosis were updated/added as needed. DHW or designee will educate the supervisor team on ensuring that appropriate diagnosis are in place for every medication ordered. DHW or designee will review current physician orders sheets for residents and identify any additional updates needed.
Standard #:	22VAC40-90-30-C
Description:	Based on record review, the facility failed to ensure staff did not make materially false statements on the sworn statement or affirmation. Evidence: 1. The sworn statement asks the question, ?Have you ever been convicted of a law violation(s) but excluding offenses committed before your eighteenth birthday that were finally adjudicated in a juvenile court or under a youth offender law??. The following two staff answered "No" to this question although each had a conviction(s) on their criminal history report: a. Staff #6?s date of hire is 7-07-2022. Staff?s sworn disclosure was dated 7-06-2022 and criminal history report was dated 7-07-2022. b. Staff #7?s date of hire is 7-05-2022. Staff?s sworn disclosure was dated 7-01-2022 and criminal history report was dated 7-07-2022.
Plan of Correction:	No negative outcome occurred as a result of this practice. Employee #6: This employee does not have any convictions that are classified as barrier crimes to employment in Assisted Living. Education was provided to the employee and a disclosure statement was updated Employee #7: This employee does not have any convictions that are classified as barrier crimes to employment in Assisted Living. Education was provided to the employee and a disclosure statement was updated The BOM or designee will audit sworn disclosure statements for all current employees. Any discrepancies will result in education and completion of a new sworn statement. The ED or designee will educate the director team on accurate completion of the sworn disclosure statement.