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: June 18, 2024 and July 9, 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: 06/18/2024 11:45am to 12:49pm, 07/09/2024 1:03pm to 1:18pm 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 04/04/2024 regarding allegations in the area(s) of: Resident care and related services, administration of medications. Number of residents present at the facility at the beginning of the inspection: 77 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 2 Number of staff records reviewed: n/a Number of interviews conducted with residents: 0 Number of interviews conducted with staff: 2 Observations by licensing inspector: Additional Comments/Discussion: 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 Becky Berry, Licensing Inspector at 276-608-3514 or by email at rebecca.berry@dss.virginia.gov.

Violations:

Standard #:	22VAC40-73-680-D
Description:	Based on review of resident records and interviews with staff, the facility failed to ensure medications shall be administered in accordance with the physician's or other prescriber?s instructions. EVIDENCE: 1. Per facility incident report and interviews with staff #1 and staff #2, resident #1 was mistakenly administered oral medications that should have been given to resident #2 by staff #2 on March 24, 2024 at approximately 9:00am. 2. Per the March 2024 Medication Administration Record (MAR) and physician?s orders, the oral medications prescribed to resident #2 for morning medication pass included the following: Benztropine Mes 0.5 Mg Tab, Carvedilol 6.25mg Tablet, Divalproex Sod Dr 500mg Tab, Famotidine 20mg Tablet, Fiber-Lax Captabs, Fluphenazine 5mg Tablet, Glimepiride 2mg Tablet, Metformin Hcl 1000mg Tablet, Omega-3 Fish Oil 1000mg Sfgl, Omeprazole Dr 40mg Capsule, APAP 325mg Tablet, Ibuprofen 400mg Tablet, Topiramate 50mg Tablet and Trihexyphenidyl 5mg Tablet. 3. Per interview with staff #1 and information received from the pharmacy, the incorrect oral medications administered to resident #1 were obtained from one pharmacy card packaged for resident #2 and included the following: Benzotropine Mes0.5 Tab (1 tablet), Famotidine 20mg Tablet (1 tablet), Fiber-Lax Captab (1 tablet), Fish Oil 1000mg Sfgl (1 capsule), Fluphenazine 5mg Tablet (1 tablet), Glimepiride 2mg Tablet (1 tablet), Metformin 1000mg (1 tablet), Omeprazole Dr 40mg Capsule (1 capsule), Topiramate 50mg Tablet (1 tablet), Divalproex Sod Dr 500mg Tab (1 tablet) and Carvedilol 6.25mg Tablet (1 tablet). 4. Per the March 2024 MAR and physician?s orders, resident #1 should have received the following oral medications during the morning medication pass on March 24, 2024: Loratadine 10mg Tablet (1 tablet), Magnesium 200 Tablet (1 tablet), Vitamin B-12 1000mcg Tablet (1 tablet), Acetaminophen 325 Tablet (2 tablets) and Omeprazole 40mg Capsule (1 capsule).
Plan of Correction:	Not available online. Contact Inspector for more information.