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: May 13, 2022

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: 05/13/2022 10:30AM through 11:10AM The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. Number of resident records reviewed: 3 Number of interviews conducted with staff: 1 Observations by licensing inspector: licensing inspector observed three residents? physician?s orders and conducted a physician?s order to medication administration record (MAR) audit to follow-up on a previously cited standard regarding medication administration. There is one repeat violation; see violation notice. 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 Jennifer Stokes, Licensing Inspector at 540-589-5216 or by email at Jennifer.Stokes@dss.virginia.gov

Violations:

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 1 contained a physician?s order, dated 03/15/2022, for Novolog three times daily before meals for diabetes and hold if blood sugar is less than 150. The May 2022 medication administration record (MAR) for resident 1 indicates that the resident?s blood sugar was 135 at 4:00PM on 05/02/2022; however, the resident was administered Novolog by staff 1 when it should have been held. 2. The record for resident 2 contained a physician?s order, dated 04/01/2022, for Humalog three times a day for diabetes and hold if blood sugar is less than 150. The May 2022 MAR for resident 2 indicates that the resident?s blood sugar was 130 at 4:00PM on 05/01/2022; however, the resident was administered Humalog by staff 1 when it should have been held. The May 2022 MAR for the resident does not contain a documented blood sugar reading by staff 3 on 05/06/2022; however, staff 3 administered the resident Humalog at 12:00PM on 05/06/2022. 3. The record for resident 3 contained a physician?s order, dated 03/15/2022, for Novolog threes daily before meals for diabetes and hold if blood sugar is less than 150. The May 2022 MAR for resident 2 indicates that the resident?s blood sugar was 143 at 7:00AM on 05/08/2022; however, the resident was administered Novolog by staff 1 when it should have been held.
Plan of Correction:	1. Staff 1 was counseled on the administration error. Medication refresher course will be completed by all Medication Aides. All medication aides will review medication management plan. To be completed by June 8th, 2022. 2. Staff 1 and 3 were counseled on the administration and MAR errors. Medication refresher course will be completed by all Medication Aides. All medication aides will review medication management plan. To be completed by June 8th, 2022. 3. Staff 1 was counseled on the administration error. Medication refresher course will be completed by all Medication Aides. All medication aides will review medication management plan. To be completed by June 8th, 2022.