VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Premier Residential and Assisted Living
904 George Washington Hwy North
Chesapeake, VA 23323
(757) 410-2754

Current Inspector: Donesia Peoples (757) 353-0430

Inspection Date: Nov. 30, 2023

Complaint Related: Yes

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 ACCOMMODATIONS AND RELATED PROVISIONS 22VAC40-73 BUILDINGS AND GROUND 22VAC40-73 EMERGENCY PREPAREDNESS 22VAC40-80 COMPLAINT INVESTIGATION

Comments:

Type of inspection: Complaint Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: An unannounced complaint inspection took place on 11/30/23 from 8:00 am to 12:30 pm. The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. A complaint was received by VDSS Division of Licensing on 11/20/23, 11/27/23, and 11/28/23 regarding allegations in the areas of: Personnel and Resident Care and Related Services Number of residents present at the facility at the beginning of the inspection: 21 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 7 Number of staff records reviewed: 3 Number of interviews conducted with residents: 4 Number of interviews conducted with staff: 3 Observations by licensing inspector: Lunch was observed and a review of the medication cart was completed. Additional Comments/Discussion: None An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation supported the allegation of non-compliance with standard(s) or law, and violation(s) were issued. Any violation(s) not related to the complaint but identified during the course of the investigation can also be found on the violation notice. 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 Donesia Peoples, Licensing Inspector at 757-353-0430 or by email at donesia.peoples@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-640-A
Complaint related:	No
Description:	Based on observation the facility failed to implement a written plan for medication management to include methods to ensure accurate counts of all controlled substances whenever assigned medication administration staff changes. Evidence: 1. The facility?s medication management plan documents the following: ?Controlled medications will be counted by two staff members at the beginning of each shift; the off-going nurse/ RMA and the on-coming nurse/RMA.? The facility did not provide documentation of controlled medications counted by two staff at the beginning of each shift for Nov. 2023. 2. Staff #1 confirmed the facility did not have documentation of controlled medications counted by two staff at the beginning of each shift for Nov. 2023.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-670-1
Complaint related:	Yes
Description:	Based on the record review and staff interview the facility failed to ensure each staff person who administers medication shall be authorized by 54.1-3408 of the Virginia Drug Control Act and shall be licensed by the Commonwealth of Virginia to administer medications or be registered with the Virginia Board of Nursing as a medication aide. Evidence: 1. During an interview with residents #1, #2, #6, and #7, the residents identified staff #2, as the staff person who administered their scheduled 8pm/night medications on 11/29/23. The record for staff #2 does not contain the following documentation: authorization and/or license by the Commonwealth of Virginia to administer medications; registration with the Virginia Board of Nursing as a medication aide; registration to act as a medication aide on a provisional basis. Staff #1 confirmed the facility did not have documentation staff #2 is licensed by the Commonwealth of Virginia to administer medications, And/or registered with the Virginia Board of Nursing as a medication aide or registered to act as a medication aide on a provisional basis. Staff #2 is listed on the facility staff list as a personal care aide. 2. Staff #1 confirmed that staff #2 used staff #1 login credentials for the EMAR system and staff #2 administered the following scheduled 8pm medications to residents #1, #2, #6, and #7 on 11/29/23: Eliquis, Buspirone and Risperidone (resident #1); Divalproex, and Lantus Solostar Injection (resident #2); Systane Utra Eye drop (resident #7); Hydroxyzine and Trazadone (resident #6).
Plan of Correction:	Not available online. Contact Inspector for more information.