VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Gray Ridge Village LLC
155 Ridgefield Rd
Marion, VA 24354
(276) 521-0784

Current Inspector: Rebecca Berry (276) 608-3514

Inspection Date: Jan. 4, 2022

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES 22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-73 RESIDENT ACCOMODATIONS AND RELATED PROVISIONS 22VAC40-73 BUILDING AND GROUNDS

Comments:

One licensing inspector and the local ombudsmen conducted an unannounced non-mandated complaint inspection on 01/26/2022 at Gray Ridge Village. The Licensing office received a complaint on 01/04/2022 regarding allegations of issues with resident care, physical plant, resident furnishings and mice in the building. The inspection started at 9:30 am and concluded at 1:10 pm. As a result of this inspection the complaint was determined to be valid and 6 violations are being cited. An IPOC will be scheduled to allow the facility the opportunity to develop a detailed plan of correction . If you have any questions or concerns please contact your inspector at 276-608-3514. Thank you for your cooperation and assistance.

Violations:

Standard #:	22VAC40-73-680-D
Complaint related:	No
Description:	Based on observations made during the inspection of the physical plant, the facility failed to ensure medications shall be administered in accordance to physicians or other prescriber?s instructions and consistent with the standards of practice outlined in the current registered medication aide curriculum approved by the Virginia Board of Nursing EVIDENCE: 1. Resident # 17 is prescribed Ipratropium-Albuterol 0.5 (2.5) Mg/3 Ml, use 1 treatment via nebulizer three times daily for COPD. According to the most recent Uniform Assessment Instrument (UAI) for resident #17 dated 10/13/2020 rates him dependent in medication administration. The LI observed the bulb of the nebulizer ? of the way full of medication on the resident night stand. The medication was observed at approximately 12:00 pm and the medication was administered at 10 am. There was dirt observed in the mouth piece of the nebulizer. The administrator reported the mouth piece is to be replaced at least every other week.
Plan of Correction:	See Intensive Plan of Correction.
Standard #:	22VAC40-73-700-2
Complaint related:	No
Description:	Based on observations made during the inspection of the physical plant, the facility failed to post ?No Smoking-Oxygen in Use? sign in any room of a building where oxygen is in use. EVIDENCE: 1. Resident #29 is on oxygen and an oxygen concentrator was observed to be in his room. There was no sign posted in his room or on the door that oxygen was in use.
Plan of Correction:	See Intensive Plan of Correction.
Standard #:	22VAC40-73-750-C
Complaint related:	No
Description:	Based on observations made during the inspection of the physical plant and an interview with one resident, the facility failed to maintain written specification that a resident does not wish to have an item in his room. EVIDENCE: 1. The LI observed resident # 15 to not have a bottom sheet on his bed. Resident # 15 told the LI he does not want a sheet on his bed. When the LI asked the administrator if there was written specification between the facility and the resident, she reported there was no written specification in his chart.
Plan of Correction:	See Intensive Plan of Correction.
Standard #:	22VAC40-73-860-D
Complaint related:	No
Description:	Based on observations made during the inspection of the physical plant, the facility failed to ensure any operable window shall be effectively screened. EVIDENCE: 1. In resident #5?s room there was a large gap observed between the window air conditioning panel and the window with no screen allowing cold air and vermin to enter the room. 2. In resident room # 28 there were two windows to the outside and neither had screens on them. 3. In resident room # 31 there were two windows to the outside and neither had screens on them. 4. In resident room # 32 there were two windows to the outside and neither had a screen on them. The window containing the air condition unit had a large gap between the air conditioning panel and the window with no screen allowing cold air and vermin to enter the room. 5. In resident #26?s room there were two windows to the outside and neither one had a screen on them. The left screen was observed laying on the ground outside the window. 6. In resident #27?s room there were two windows to the outside and the left window was observed to not have a screen on it. 7. In resident #12?s room there were two windows to the outside and neither window was observed to have a screen on them. A piece of cardboard had been duct taped around the window air conditioning panel and the window to help keep cold air and vermin out. 8. In resident room # 36 there were two windows to the outside and neither window was observed to have screens on them. 9. None of the windows located in the common sitting area leading to the outside were observed to have screens on them.
Plan of Correction:	See Intensive Plan of Correction.
Standard #:	22VAC40-73-870-A
Complaint related:	No
Description:	Based on the observations made during the inspection of the physical plant, the facility failed to ensure the interior and exterior of all buildings shall be maintained in good repair and kept clean and free of rubbish. EVIDENCE: 1. There was a punching bag observed to be laying on the ground and a metal tin filled with cigarettes and trash on the porch of the courtyard. 2. There was trash observed on the ground around the trash can on the porch at the end of A hall. 3. The door leading to the outside courtyard located in the common sitting area had a piece of yellow caution tape tied to it and a note posted on the door stating door is inoperable do not use repair is needed. The administrator reported the door has been inoperable for sometime.
Plan of Correction:	See Intensive Plan of Correction.
Standard #:	22VAC40-73-870-E
Complaint related:	No
Description:	Based on observations made during the inspection of the physical plant, the facility failed to ensure all furnishings, fixtures, and equipment including furniture, window coverings, sinks, toilets, bathtubs and showers shall be kept clean and in good repair. EVIDENCE: 1. Resident # 1 was observed sleeping on his bed with his sheet hanging off of the side of his bed. His sheet was observed to have a large yellow stain on it. 2. The top drawer of the night stand belonging to resident # 3 was unsteady and unsecure falling off of the track into the floor when opened. 3. The night stand located on the left side of the room in resident # 4?s room was observed to have a broken bottom drawer. 4. Resident #5 did not have a sheet on his bed. The LI asked if staff had stripped his bed on the day of inspection and he stated ?his bed was not stripped today but they are going to put the sheet back on today.? 5. The mattress on the spare bed in resident # 11?s room was observed to be ripped and torn. 6. The dresser belonging to resident # 11 was observed to have two drawers that were broken and unsecure. The bottom drawer of the nightstand belonging to resident #11 had no handles on the bottom drawer so the drawer could not be pulled out. 7. The night stand belonging to resident # 6 had broken and unsteady drawers. The bottom drawer of his night stand was full of dirt, debris and what appeared to be tobacco. 8. The second drawer in the chest of drawers belonging to resident #8 was broken and unsecure on the track and was heavy with clothing. When the LI tried to pull it out the drawer almost fell out completely. 9. The toilet in the bathroom belonging to resident #8 had a loose toilet seat that did not fit the toilet properly. The toilet was oval and the toilet lid was round. The lid on top of the tank did not fit properly and was loose. 10. Resident #9 told the LI her shower did not work due to a leak and had not worked in over a month. She has to go to the common shower in the front of the facility to shower. The LI observed the shower in resident #9?s bathroom to be inoperable. 11. The clothing belonging to resident # 10 was observed to be in trash bags on top of her dresser. When the LI asked resident #10 about her clothes being in trash bags she told the LI she did not want to use the dresser provided to her because it was old and broken. She said her family was bringing a new dresser to her. 12. There was an extension cord observed hanging from the dresser belonging to resident #11 with all six outlets filled. 13. Resident #15 was observed lying in his bed without a bottom sheet. When the LI entered his room he sat up on the side of the bed and the LI observed his mattress to be ripped and torn. When the LI asked about the bottom sheet not being placed on his bed he told the LI he does not want a sheet on his bed. 14. The toilet tank lid in resident # 15?s bathroom was observed to not fit properly and was loose. 15. When the LI was leaving resident #15?s room the resident from across the hallway which was resident #16 was observed to be coming into resident #15?s room to use the restroom. 16. When the LI asked resident #16 why he was not able to use the bathroom in his room he told the LI his toilet had not worked in over a week. The LI observed water around the toilet in resident # 16?s bathroom and the toilet appeared to be inoperable. 17. The bathroom door in resident #19?s room had what appeared to be a dark, dried liquid stain running down the front of the door. * Additional information is attached in a word document.
Plan of Correction:	See Intensive Plan of Correction.