VIRGINIA DEPARTMENT OF SOCIAL SERVICES

August Healthcare at Richmond
1503 Michaels Road
Henrico, VA 23229
(804) 288-6245

Current Inspector: Coy Stevenson (804) 972-4700

Inspection Date: Dec. 7, 2021

Complaint Related: No

Areas Reviewed:

22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES 22VAC40-73 ADMISSION, RETENTION, AND DISCHARGE OF RESIDENTS 22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-80 THE LICENSE.

Comments:

A monitoring inspection was conducted on December 7, 2021 from 11:00 a.m. to 2:24 p.m. The Administrator and Director of Nursing were present during the inspection. The facility?s census was 19. The areas reviewed included buildings and grounds, medication administration, record records, healthcare oversight, emergency supplies, menus, and activity calendars. The findings were reviewed with the Administrator and Director of Nursing onsite.

Violations:

Standard #:	22VAC40-73-50-B
Description:	Based on record review and interview with staff, the facility failed to ensure written acknowledgment of the receipt of the disclosure by the resident or his legal representative shall be retained in the resident's record. Evidence: 1. Resident #1, Resident #2, and Resident #3?s records did not contain a written acknowledgment of the receipt of the disclosure by the resident or his legal representative 2. Staff #2 confirmed the disclosure was not being provided and documented in the three residents? records.
Plan of Correction:	1. Resident # 1, 2 and 3 have signed a written acknowledgment of the receipt of the disclosure. 2. All residents records will be reviewed to ensure the written acknowledgment of the receipt of the disclosure is present. 3. Administrator will educate the admissions Coordinator of the importance of having the resident or his legal representatives sign the receipt of the disclosure. 4. Administrator/designee will monitor new admissions for the receipt of disclosure weekly X 4 weeks and monthly X 2 months.
Standard #:	22VAC40-73-320-A
Description:	Based on record review and interview with staff, the facility failed to ensure the physical examination contained description of the person?s reactions to any known allergies. Evidence: 1. Resident #2?s physical examination dated 11-01-2021 documented Morphine or adhesive bandages as the resident?s allergies; however, the examination did not contain a description of the resident?s reactions. 2. Staff #2 confirmed during interview Resident #2?s reactions to known allergies were not documented on the physical examination.
Plan of Correction:	1. Resident #2's physical examination dated 11-1-2021 does now contain a description of the resident's reaction to allergies. 2. Resident #2 and all current residents? physical examinations have been reviewed to ensure reactions are listed for known allergies. 3. The Admissions Coordinator, Physician and AL F coordinator have been educated by the Administrator to ensure the reactions are listed on the physical examination for any known allergies. 4. Administrator/designee will monitor weekly X 4 weeks and monthly X 2 months that the description of any known allergies with the resident?s reaction are listed on the physical examination.
Standard #:	22VAC40-73-410-A
Description:	Based on record review and interview with staff, the facility failed to ensure upon admission, the assisted living facility shall provide an orientation for new residents and their legal representatives. Acknowledgment of having received the orientation shall be signed and dated by the resident and, as appropriate, his legal representative, and such documentation shall be kept in the resident's record. Evidence: 1. Resident #1, Resident #2, and Resident #3?s records did not contain the acknowledgment of having received orientation. 2. Staff #2 confirmed the orientation was not being completed and documented in the three residents? records.
Plan of Correction:	1. Residents #1, 2 and 3 have orientation and acknowledgment of having received the orientation have also been signed, dated and kept in the resident record. 2. All residents records will be reviewed to ensure that they received orientation on admission and acknowledgment of having received the orientation have also been signed, dated and kept in the resident record. 3. Administrator/designee have educated Admissions and the nursing staff on the importance of new admissions receiving orientation and acknowledgment of having received the orientation being kept in the resident record. 4. Administrator/designee will monitor new admissions receiving orientation on admission X4 weeks and then monthly X 2 months.
Standard #:	22VAC40-73-450-C
Description:	Based on record review and interview with staff, the comprehensive individualized service plan (ISP) shall include description of identified needs and date identified based upon the Uniform Assessment Instrument (UAI). Evidence: 1. Resident #3 admitted 9-28-2021 to the facility. Resident #3?s UAI dated 8-18-2021 documented the resident requires assistance with glucose checks once a day and has partial paralysis/numbness from mini strokes. Resident #3?s UAI also documented the resident requires assistance with transportation, shopping, home maintenance; however, none of these needs were addressed on the resident?s ISP dated 9-29-2021. 2. Staff #2 confirmed the required information was not on the Resident #3?s ISP based on identified needs from the UAI.
Plan of Correction:	1. Resident #3 ISP was updated to reflect the resident requires assistance with glucose checks once a day and has partial paralysis/numbness from mini strokes and the resident requires assistance with transportation, shopping, and home maintenance. 2. All residents ISP's will be reviewed to ensure the ISP matches the UAI. 3. Administrator/designee will educate facility Social Worker and AL Coordinator on the importance of ensuring ISP's are updated according to the residents UAI. 4. Administrator /designee will monitor ISP's are Updated according to the UAI. weekly X 2 weeks and monthly X 2 months.
Standard #:	22VAC40-73-680-D
Description:	Based on record review and interview with staff, the facility failed to ensure medications were administered in accordance with the physician's instructions. Evidence: 1. Resident #2?s Digoxin Tablet 125 mcg order dated 11-04-2021 documented, ?1 tablet by mouth one time a day for health failure?. Resident?s #2?s order was not administered/held on four days on the December 2021 Medication Administration Record (MAR). Staff #2 stated the medication was held due to the resident?s pulse being below 60; however, Resident #2?s physician?s order did not document instructions for holding the medication. 2. Staff #1 and Staff #2 confirmed during interview Resident #2?s Digoxin was not administered in accordance with the physician?s instructions.
Plan of Correction:	1. Resident #2's physician order for Digoxin Tablet 125 mcg was clarified with instructions to say check for pulse prior to administration and to hold medication if pulse is below 60. 2. All residents with an order for digoxin have been audited to ensure that there is an order to check pulse before digoxin administration and to hold if pulse is less than 60. 3. Licensed Nurses will be educated on the importance of following physicians? orders and/or getting an order to clarify instructions. 4. Administrator/designee will monitor weekly X 4 weeks and monthly X2 months that all residents taking Digoxin have an order with instructions to hold the medication if pulse is below 60.
Standard #:	22VAC40-73-700-1
Description:	Based on record review and interview with staff, the facility failed to ensure when oxygen therapy is provided, the facility shall have a valid physician's or other prescriber's order that includes the oxygen source, such as compressed gas or concentrators and the delivery device, such as nasal cannula, reservoir nasal cannulas, or masks. Evidence: 1. Resident #1?s physician?s orders dated 10-28-2021 for oxygen documented, ?Oxygen at 2L/minute for Shortness of Breath or pulse ox below 93%?. The order did not identify the oxygen source and the delivery device. 2. Staff #2 confirmed during interview the aforementioned information was not documented on Resident #1?s oxygen order.
Plan of Correction:	1. Resident #1 physician's orders have been clarified with the oxygen source and the delivery device. 2. All residents receiving oxygen have been audited to ensure an oxygen source and delivery device is present on the order. 3. Administrator/designee will educate the nursing staff on ensuring all oxygen orders have oxygen source and delivery source. 4. Administrator/designee will monitor physician orders having a oxygen source and delivery device weekly X4 weeks and monthly X 2 months.
Standard #:	22VAC40-80-120-A-1
Description:	Based on observation and interview with staff, the facility failed to ensure it was operating within the terms of its license, which include the operating name of the facility, and the name of the corporation sponsoring the facility. Evidence: 1. The facility is currently operated by the existing license; however, the following documents had August at Richmond listed as the facility: a. Resident #1?s ?Resident Agreement?; b. Resident #1?s ?Report of Resident Physical Examination?; c. Resident #2?s ?Resident Agreement?; d. Resident #2?s ?Emergency Contact Form?; and e. Resident #2?s ?Report of Resident Physical Examination?. 2. Additionally, Resident #1?s physician?s orders dated 10-28-2021 documented the facility as Little Sisters of the Poor. 3. Staff #1 acknowledged during the onsite inspection that the facility was not operating within the terms of its license due to not including the current operating name of the facility and name of corporation sponsoring the facility on Resident #1?s and Resident #2?s paperwork.
Plan of Correction:	1.Resident #1 has resigned the Resident agreement and Report of Resident Physical Examination. Resident #1 physician orders are now documented in the appropriate. license name. Resident #2 has resigned the Resident Agreement, Emergency Contact Form and Report of Resident Physical Examination. 2. All of the admissions since 10-1-2021 will be audited to ensure appropriated licensed name is on the Admission paperwork and physicians? orders. 3. Administrator/designee will educate Admissions and ALF Coordinator on the importance of using the existing license for all documents. 4. Administrator/designee will randomly monitor all documents used in the facility to ensure they have the appropriate license name listed.