VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Masonic Home of Virginia
500 Masonic Lane
Henrico, VA 23223
(804) 222-1694

Current Inspector: Tamara Watkins (804) 662-7422

Inspection Date: April 30, 2021

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:

This inspection was conducted by licensing staff using an alternate remote protocol necessary due to a state of emergency health pandemic declared by the Governor of Virginia. A monitoring inspection was initiated on 4/30/2021 and concluded on 5/12/2021. The administrator was contacted by telephone to initiate the inspection. The administrator reported that the current census was 81. The inspector emailed the administrator a list of items required to complete the inspection. The inspector reviewed (5) five resident records, (5) five staff records, staff schedules, medication administration records, service plans and other required documentation submitted by the facility to ensure documentation was complete. Information gathered during the inspection determined non-compliance(s) with applicable standards or law, and a violation was documented on the violation notice issued to the facility.

Violations:

Standard #:	22VAC40-73-680-D
Description:	Based on a review of the residents medication administration record the facility failed to administer medication(s) in accordance with the physician's order. Evidence: The March 2021 electronic medication administration record for resident #1 documented that the resident did not receive their prescribed medication, Diclofenac Sodium 3% gel on 3/19 at 8:30a; 3/30 at 5p and 3/31 at 8:30a. The documented reason given was "out of medication"; "pharmacy notified"; "medication has been reordered."
Plan of Correction:	Three staff members did not follow Masonic Home's Policy: Medication Management Plan will have 1:1 education with Nurse Management. 5/21/2021 Medication Management Plan reviewed with all staff that pass medication and do treatments throughout the home. (All RN's, LPN's, Med Tech's). Staff to sign off that they have read and understand policy as written. PRN staff may email acknowledgement that they have read and understand policy as written. 5/25/2021