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Shelton on the Bay
1300 N. Mallory Street
Hampton, VA 23663
(757) 723-6669

Current Inspector: Willie Barnes (757) 247-8053

Inspection Date: April 8, 2013

Complaint Related: Yes

Areas Reviewed:
22VAC40-72 PERSONNEL.
22VAC40-72 STAFFING AND SUPERVISION.
22VAC40-72 RESIDENT CARE AND RELATED SERVICES
22VAC40-72 EMERGENCY PREPAREDNESS.
22VAC40-72-440-D When hospice care is provided to a resident, the assisted living facility and the licensed hospice organization shall communicate, establish and agree upon a coordinated plan of care for the resident. The services provided by each shall be included on the individualized service plan.
22VAC40-72-450 Personal care services and general supervision and care.
22VAC40-72-460 Health care services.

Comments:
The licensing inspector conducted an unannounced complaint inspection in response to a complaint that was received by the regional licensing office on 2/19/13. Interviews were conducted with facility staff and resident relating to allegations that resident not receiving care and fire drills performance. The information gathered during the investigation support the allegation of resident not receiving care, so the complaint for this allegation is valid. Please complete the columns for "description of action to be taken" and "date to be corrected" for each violation cited on the violation notice, and then return a signed and dated copy to the licensing office within 10 calendar days of receipt. If you have any questions, contact your licensing inspector at (757) 247-8053.

Violations:
Standard #: 22VAC40-72-450-A
Complaint related: Yes
Description: Based on record review and and staff interview, the facility failed to ensure that the health, safety and well-being of a resident was monitored. Evidence: 1. On 4/8/13, the licensing inspector's review of Resident #1's record revealed that Resident #1's record revealed that on 3/30/13, the resident sustained a fall, was sent to the local emergency room and returned with information noting that the resident sustained a head wound, seven staple. Resident record did not note staff monitoring wound area per discharge document for head wound and staples. 2. On 4/8/13, the licensing inspector review of the facility's communication log, resident's record, staff interviews, and the hospice nurse's revealed that there was no documentation of staff's monitoring the resident's staples for bleeding, swelling or other negative health signs following the resident's return to the facility on 3/30/13. 3. On 4/8/13, the facility's staff , upon contacting a hospice staff, received documentation from the hospice agency noted "head wound care to be provided" document dated 4/1/13. Staff at the facility not aware of document, not available in chart prior to the inspector's inquiry of documentation of facility staff monitoring of the resident's head wound/staples.

Action to be Taken: D.O.N. or Admin will check communication book every a.m. to assure that staff is documenting properly. Hospice was notified that the hospice nurse will have to chart on each res. that is under their care everytime they visit that resident and leave a copy in the chart and report to the nurse on duty.

Standard #: 22VAC40-72-940-A
Complaint related: Yes
Description: Based on document review and staff interviews, the facility failed to ensure the facility had a written plan for fire and emergency evacuation that is to be followed in the event of a fire or other emergency. The plan shall be approved by the appropriate fire official. Evidence: 1. On 4/8/13, the licensing inspector (LI) requested a copy of the facility's fire drill policy after observing a mock fire drill conducted at 06:47 am and completed at 07:00 am. Staff #1 showed the LI the current fire document, last updated 2009. The policy and procedures contained copies of the Virginia Fire Code, not a facility policy and procedures indicating what and how the facility staff would proceed during a fire or emergency. 2. LI's conversation with Staff #4, person-in-charge, revealed staff unsure about how to proceed during a mock fire drill procedure. 3. Mock fire drill, fire location in the solarium of the facility. Residents observed entering the solarium area, when instructed that the fire was in the solarium, ambulatory residents unsure what to do and where to go, alternate exit unclear for residents. LI's interview with staff and residents revealed the solarium was the area where residents, particularly wheelchair and walkers exited during fire drills. Residents in wheelchairs/ walkers unaware of alternative route.

Action to be Taken: Step by step fire drill instructions will be posted in the med room on the fire panel. Admin will perform all fire drills until she feels comfortable that all staff members are doing them properly. Performed fire drill and had in-service on instructions for a fire drill.

Disclaimer:
A compliance history is in no way a rating for a facility.

The online compliance history includes only information after July 1, 2003. In addition, the online compliance history includes information regarding adverse actions that may be the subject of a pending appeal. An adverse action is not final until a provider has exhausted or waived all due process rights. For compliance history prior to July 1, 2003, or information regarding the status of pending adverse actions, please contact the Licensing Inspector listed in the facility's information. The Virginia Department of Social Services (VDSS) is not responsible for any errors in or omissions from the compliance history information.