VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Meadow Glen of Leesburg
315 Dry Mill Road
Leesburg, VA 20175
(703) 737-6149

Current Inspector: Jacquelyn Kabiri (703) 397-3017

Inspection Date: May 22, 2019

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 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.

Comments:

An unannounced renewal inspection was conducted on 5/22/19. At the time of entrance, 34 residents were in care. A meal, medication administration and activities were observed. Building and grounds were inspected and records were reviewed. The sample size consisted of six resident records and three staff records. Violations were discussed and an exit meeting was held. Areas of non-compliance are identified on the violation notice. Please complete the 'plan of correction' and 'date to be corrected' for each violation cited on the violation notice and return to the licensing office within 10 calendar days. Please specify how the deficient practice will be or has been corrected. Just writing the word 'corrected' is not acceptable. The 'plan of correction' must contain: 1) Steps to correct the non-compliance with the standards, 2) Measures to prevent the non-compliance from occurring again, and 3) Person responsible for implementing each step and/or monitoring any preventative measures. Thank you for your cooperation and if you have any questions, please contact me via e-mail at m.massenberg@dss.virginia.gov.

Violations:

Standard #:	22VAC40-73-320-A
Description:	Based on record review, the facility failed to ensure that the physical examination report includes all of the required information. Evidence: The physical examination form for Resident #2, dated 7/19/18, did not include the resident's reactions to known allergens. The physical examination form for Resident #3, dated 2/11/19, did not include the resident's reactions to known allergens.
Plan of Correction:	Resident #2 and #3 had a physical report and the resident?s allergies where stated on the physical the reaction to the allergy was not stated on the physical. The RCC called and received the reactions to the allergy on 5/30/2019 and placed that information in the resident charts. The ED and RCC will review the physical prior to placing in the resident chart to ensure that all required information is present.
Standard #:	22VAC40-73-680-D
Description:	Based on observation and documentation, the facility failed to ensure that medication is administered in accordance with the physician's instructions and consistent with the standards of practice outlined in the current registered medication aide curriculum approved by the Virginia Board of Nursing. Evidence: The morning medication administration for Resident #3 was observed during the inspection. The resident's medication was placed into a pill cup for administration and the medication packages were returned to the cart. Before the medication was administered, the licensing inspector asked about the resident's Calcium Antacid, as only one Calcium Antacid tablet was in the pill cup. The order for Resident #3's Calcium Antacid, dated 3/8/19, calls for the resident to receive two tablets of Calcium Antacid. A Lidocaine patch was applied to Resident #3, during the morning medication administration. Prior to applying the patch, the staff member removed the patch that was applied the previous day. Resident #3's order for the Lidocaine patch, dated 3/8/19, called for a patch to be applied in the morning and for the patch to be removed at bedtime. Resident #3's Lidocaine patch was not removed on 5/21/19.
Plan of Correction:	Resident #3 did receive the correction medication per the order after review of the order. The RMA failed to remove the patch on the 3-11 shift as per the order the 7-3 RMA removed the patch and placed a new patch on per the order. The resident?s physician was notified of medication error. The RCC will have a pharmacist complete an in-service on June 11th at 2:00 pm to review medication plan and the proper procedure to check an order prior to administration. The RMA passing medication is responsible to pass medication per the guidelines.
Standard #:	22VAC40-73-990-C
Description:	Based on documentation, the facility failed to ensure that all staff currently on duty on each shift, participate in an exercise in which the procedures for resident emergencies are practiced. Evidence: No documentation was presented to confirm that a practice exercise, for resident emergency procedures, was completed within the past six months. A review of resident emergency procedures was conducted on 1/25/19, but no information was provided to document the completion of an exercise within the past six months.
Plan of Correction:	Emergency Preparedness and missing person, mental health and medical emergency and fire drill were completed on 1/25/19. All employees attended that meeting a fire drill was performed and missing persons, mental health and medical emergencies were discussed. Each staff member that attended had signed the in-service sheet and all participants were included in the fire drill. The in-service was listed in each employee chart. The ED and BOM will assure that all documentation for further drills are completed and updated in both the employee chart and notebook.