VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Green Acres
481 Bradley Street SW
Abingdon, VA 24210
(276) 258-5721

Current Inspector: Rebecca Berry (276) 608-3514

Inspection Date: Jan. 12, 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 ACCOMODATIONS AND RELATED PROVISIONS 22VAC40-73 BUILDING AND GROUNDS 22VAC40-73 EMERGENCY PREPAREDNESS 22VAC40-90 The Sworn Statement or Affirmation 22VAC40-90 The Criminal History Record Report

Comments:

Two licensing inspectors conducted an unannounced mandated license renewal inspection at Green Acres on 01/12/2022. The inspection started at 10:40 am and concluded at 3:00 pm. A sample of resident and staff files were reviewed. Required posting's were checked. The medication cart and Medication Administration Records were reviewed. Lunch and snacks were observed being served. Staff and resident interactions were observed. An exit meeting was held with the administrator and other key staff on 01/12/2022 and at that time an opportunity was given to find items that were not available in files. As a result of this inspection 3 violations are being cited. Please develop a plan of correction for each of the cited violations along with a date of correction and return a signed and dated copy back to the licensing office within 10 calendar days (01/24/2022) of receipt. If you have any questions or concerns please contact your inspector at 276-608-3514. Thank you for your cooperation and assistance.

Violations:

Standard #:	22VAC40-73-320-A
Description:	Based on documentation review of the physical examination reports, the facility failed to ensure the physical examination report contained all of the required information for two residents in care. EVIDENCE: 1. The physical examination report for resident # 7 dated 9/3/2021 did not include the resident's height, weight, blood pressure, allergies and the description of the resident's reactions. The tuberculosis assessment form for resident # 7 dated 9/3/2021 did not have the results of the assessment documented. 2. The physical examination report for resident # 9 dated 9/3/2021 did not include the resident's weight. The tuberculosis assessment form for resident # 9 dated 9/3/2021 did not have the results of the assessment documented.
Plan of Correction:	1. All physicals and TB forms will be reviewed for completion and accuracy prior to admission. Administrative staff to monitor and follow-up. [sic]
Standard #:	22VAC40-73-450-C
Description:	Based on documentation review Individual Service Plans (ISPs), the facility failed to include the description of identified needs from other sources on the ISP for one resident in care. EVIDENCE: 1. Resident # 2 was admitted to the facility on 12/09/2021. The facility has a Discharge Assistance Program financial agreement with the local Community Services Board to provide financial assistance for resident # 2 until his social security is reinstated. The ISP for resident # 2 dated 12/09/2021 did not have the financial agreement documented.
Plan of Correction:	1. All DAP agreements regarding financials will be documented on all ISPs moving forward. [sic]
Standard #:	22VAC40-73-710-F
Description:	Based on documentation review of Individual Service Plans (ISPs), the facility failed to review the ISP for one resident in care within a week of the application of an emergency restraint and document additional interventions to prevent the future use of emergency restraints. EVIDENCE: 1. Resident # 2 was restrained on an emergency basis on 01/02/2022 by facility staff due to harmful behavior to himself and others. The ISP for resident # 2 dated 12/09/2021 did not document the use of the emergency restraint or interventions to prevent the future use of emergency restraints on the day of inspection. 2. Staff # 6 confirmed she had not reviewed the ISP and documented interventions to prevent to use of emergency restraints within a week of the application of the emergency restraint.
Plan of Correction:	1. In the event were the use of an emergency restraint shall be used in the future. Administrative staff will document use of emergency restraint on ISP with follow-up. [sic]