VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Red Oak Manor
18360 Virgil Goode Hwy
Rocky mount, VA 24151

Current Inspector: Angela Marie Swink (276) 623-6575

Inspection Date: April 7, 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 22VAC40-73 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.

Comments:

The licensing inspector (LI) for Red Oak Manor in conjunction with another LI, conducted an unannounced renewal study on 04/07/2022 from 9:00 AM until 2:45PM, finding 42 residents in care. The inspection included a tour of the physical plant, observation of a medication pass, a review of the medication storage carts, and staff/resident interviews. Eight resident records were thoroughly reviewed. Sworn disclosure statements and criminal record checks were examined for all newly hired staff, and the records of four staff were thoroughly examined. Additional facility documentation was surveyed for compliance with the Standards for Assisted Living Facilities. Findings were reviewed with facility staff during the inspection. An exit interview was conducted with the direct care staff in charge on the date of inspection, where findings were reviewed and an opportunity was given for questions, as well as for providing any information or documentation which was not available during the inspection. Please complete the ?plan of correction? and ?date to be corrected? for each violation cited on the violation notice and return it to your licensing inspector within 10 calendar days from today. If you have any questions, contact your licensing inspector at (540) 589-5216.

Violations:

Standard #:	22VAC40-73-260-A
Description:	Based on staff record review and staff interview, the facility failed to ensure that direct care staff members shall maintain current certification in first aid. EVIDENCE: The record for staff 2 contained documentation of first aid certification which expired 01/17/2022. Interview with staff 3 indicated that first aid certification for staff 2 is expired.
Plan of Correction:	All direct care staff will have first aide. Staff 2 will be set up with first available class.
Standard #:	22VAC40-73-440-D
Description:	Based on resident record review and staff interview, the facility failed to ensure that for private pay individuals, the uniform assessment instrument (UAI) was completed as required. EVIDENCE: The UAI for resident 8, dated 08/01/2021, indicated that the resident does not need assistance with bathing. The individualized service plan (ISP) for the resident, dated 08/01/2021, indicated that the resident needs mechanical help with bathing. Interview with staff 3 revealed that the ISP is correct and the UAI is incorrect.
Plan of Correction:	Will review and have administrator review all UAI. Corrected day of inspection.
Standard #:	22VAC40-73-520-I
Description:	Based on observation during a tour of the physical plant, the facility failed to ensure there shall be a written schedule of activities that includes the hour of the activity. EVIDENCE: While performing the physical plant tour of the facility, one licensing inspector (LI) observed the April 2022 activity calendar posted on the wall; however, the activities for each day did not include scheduled times.
Plan of Correction:	This standard will be reviewed by all staff that help in activities. This was corrected on 4/9/22.
Standard #:	22VAC40-73-640-A
Description:	Based on document review, the facility failed to implement their medication management plan. EVIDENCE: 1. The facility?s medication management plan contained the following: ?Control medication will be placed [sic] a lock compartment on the medication cart. When giving this medication, there will be a separate document that will need to be signed, as well as continued count of the medication being used. At the end of each shift, and the beginning of another shift, the two medication technicians Will perform a count of all controlled medication in the locked drawers, to ensure all control medications given on the shift has been correctly documented.? 2. The ?Red Oak Manor Control Sheet Bottom Cart? log was missing three signatures from 04/04/2022 through 04/07/2022. Interview with staff 3 revealed that she was the staff person who should have signed these.
Plan of Correction:	All medication aides will review medication management plan. The Head RMA spoke with the RMA that made the mistake on day of inspection.
Standard #:	22VAC40-73-680-D
Description:	Based on resident record review, the facility failed to ensure that medications were administered in accordance with the physician?s or other prescriber?s instructions. EVIDENCE: 1. The record for resident 4 contained a physician?s order, dated 01/04/2022, for Novolog 100 unit/ML inject 8 units sub-q 3 times daily before meals for diabetes hold if blood sugar is less than 150. 2. The March 2022 medication administration record (MAR) for the resident contains documentation that the resident?s blood sugar was 80 at 7AM on 03/29/2022; however, the March 2022 MAR showed that the resident?s Novolog was administered at 7AM when it should have been held.
Plan of Correction:	All medication aides will review medication management plan. Head Med Aide spoke with staff. This was fixed day of inspection.
Standard #:	22VAC40-73-720-A
Description:	Based on resident record review, the facility failed to ensure that a Do Not Resuscitate (DNR) order is included in the individualized service plan (ISP). EVIDENCE: The record for resident 7 contained a signed DNR order which was completed on 08/24/2020; however, the ISP for resident 7, dated 01/03/2022 did not indicate that resident 7 has a DNR order.
Plan of Correction:	All orders will be checked and reviewed. The others will be on the ISP. This was corrected 4/8/2022.