VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Virginia Veterans Care Center
4550 Shenandoah Ave.
Roanoke, VA 24017
(540) 982-2860

Current Inspector: Angela Marie Swink (276) 623-6575

Inspection Date: Oct. 3, 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 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 SANCTIONS.

Comments:

On 10/3/2019 three licensing inspectors conducted a renewal study (8:20am to 1:45pm). 26 residents were in care. Six resident records and three staff records were fully reviewed, and new staff records were reviewed for background checks. A medication pass was observed. Residents and staff were interiewed. A physical plant tour was done. Please complete the plan of correction and date to be corrected for each violation cited on the violation notice and return it to your licensing inspector within 10 calendar days from today. You will need to specify how the deficient practice will be or has been corrected. Just writing the word ?corrected? is not acceptable. Your plan of correction must contain the following: 1) steps to correct the noncompliance with the standard(s); 2) measures to prevent the noncompliance from occurring again; and 3) person(s) responsible for implementing each step and/or monitoring any preventive measure(s). If you have any questions, please contact your licensing inspector at 540-309-3043.

Violations:

Standard #:	22VAC40-73-290-A
Description:	Based on observation, the facility failed to maintain a written work schedule with an indication of whomever is in charge at any given time. EVIDENCE: 1. The staff schedule dated September 22, 2019 to October 19, 2019 does not show which direct care staff person is in charge in the absence of management staff.
Plan of Correction:	1. The staffing schedule template was amended to reflect who is listed as in charge. 2. The staffing schedule will be reviewed daily for compliance. 3. The DON and/or designee will be responsible.
Standard #:	22VAC40-73-390-C
Description:	Based on review of resident records, the facility failed to ensure original resident agreements were updated along with changes to policy. EVIDENCE: 1. Residents 3, 4, 5, and 6 did not have updated resident agreements to reflect changes in policy.
Plan of Correction:	1. Residents 3, 4, 5 and 6 had updated resident agreements completed, signed and placed in their records. 2. The resident agreement forms will be monitored monthly to ensure the current agreement form is being utilized. 3. The QI nurse and/or designee will be responsible.
Standard #:	22VAC40-73-450-C
Description:	Based on documentation review and resident interview, the facility failed to have a written description of what services will be provided to address identified needs, and who will provide them on the comprehensive individualized service plan (ISP). EVIDENCE: 1. Resident 6 has a uniform assessment instrument (UAI) dated 09/18/2019 and it has a power of attorney (POA) identified. An ISP was dated for 10/18/2019 on the same resident and it did not have a POA identified as a service or a need. There were no POA documents found in the file. Resident 6 stated she did have a POA when LI interviewed her.
Plan of Correction:	1. The UAI history for resident 5 was researched and it was verified by family that the resident does not have a current POA identified. The VDSS will be contacted to update this UAI. THe ISP for this resident is current and correct. 2. All UAI's that indicated an identified POA will be verified that the ISP reflects same. 3. The ALF Unit Manager and/or designee will be responsible.
Standard #:	22VAC40-73-450-F
Description:	Based on document review, the facility failed to update an individualized service plan (ISP) with updates as needed, either annually or when the condition of the resident changes. EVIDENCE: 1. The record for resident 3 shows that as of 3/19/2019 this resident no longer has a prescribed diet. The ISP dated 3/6/2018 shows the resident has a no added salt diet. The uniform assessment instrument (UAI) dated 2/21/2019 shows that resident 3 is unable to climb stairs, and this is not addressed on the ISP dated 3/6/2018. The ISP dated 3/6/2018 for resident 3 shows that treatment for weeping areas on legs were discontinued on 8/11/2018; interview with staff members reveal resident 3 still gets treatment for this problem. 2. The ISP for resident 3 is over 12 months old. It has not been updated annually.
Plan of Correction:	1. The ISP for resident 3 was corrected and updated, as well as reviewed and signed by the resident. 2. ISPs will be monitored monthly for accuracy and annual renewals. 3. The ALF Unit Manager and/or designee will be responsible.
Standard #:	22VAC40-73-610-B
Description:	Based on observation, the facility failed to have a menu for the current week dated and posted in an area conspicuous to residents. EVIDENCE: 1. The posted menus observed on 10/3/2019 were not dated for the week of the inspection.
Plan of Correction:	1. The menus were updated to reflect the date of the week for the menus posted. 2. The menu program was corrected so that all future menu printouts will reflect the menu and the related week by date. 3. The Dietary Manager or designee will be responsible.
Standard #:	22VAC40-73-640-A
Description:	Based on document review, the facility failed to implement its written plan for medication management, and failed to address a required component. EVIDENCE: 1. The facility's medication management plan states, "All controlled substances are verified by numerical count at the beginning and end of each shift by the current nurse and the oncoming nurse (including Registered Medication AIde)." This section of the plan was not implemented. During the morning of the inspection (approximately 10am), the LI noted that the 3 PM control drug balances had been counted and signed off for the day by staff 1. During the morning of the inspection (approximately 10am), the LI noted that a 1300 (1pm) dose of gabapentin for resident 3 had been signed off ahead of time by staff 1. 2. The LI observed several medications that have shortened expiration dates once they are either opened or removed from refrigeration. The facility's medication management plan does not address how to ensure medications like this are discarded by the shortened expiration date, to ensure not using outdated medications. A Novolog Flexpen for resident 8 had no open or discard date. This is good for 28 days after removing from refrigeration. A bottle of Latanoprost 0.005% for resident 11 had no open or discard date. The bottle is marked "store at room temperature for 6 weeks only."
Plan of Correction:	1, Education of all ALF nurses regarding medication practices was completed. ALF nurses that were not in compliance were counseled for corrective action. All medications that had no open or discard dates listed were disposed of. 2. The controlled substances count log will be monitored weekly for completeness. Medications will be audited monthly by the pharmacy med cart review, as well as random audits by nursing. 3. The ALF Unit Manager and/pr designee will be responsible. 1. Education of all ALF nurses regarding medication practices, specifically addressing expiration dates. The medication management plan was updated to address expiration dates. 2. Random audits will be completed weekly for 12 weeks for compliance. 3. The ALF Unit Manager and/or designee will be responsible.
Standard #:	22VAC40-73-660-A-7
Description:	Based on observation, the facility failed to have dedicated medical supplies labeled with resident names. EVIDENCE: 1. Glucometers were not labeled for individual use. The unlabeled glucometers were found in boxes labeled for residents 7, 9, and 10.
Plan of Correction:	1. The glucometers tor residents 7,9, and 10 were labeled appropriately. 2. Education was completed regarding labeling for new glucometers. Glucometers will be audited weekly for proper labeling. 3. The ALF Unit Manager and/or designee will be responsible.
Standard #:	22VAC40-73-680-B
Description:	Based on observation, the facility failed to have a prescription medication with a prescription label attached. EVIDENCE: 1. The prescription Diclofenac Gel 1% for resident 3 had no prescription label attached, nor was the box with the prescription label in the medication cart. 2. A Lantus Solostar pen, identified by staff 1 as belonging to resident 8, was not labeled with the resident's name. 3. A Novolog Flexpen, identified by staff 1 as belonging to resident 8, was not labeled with the resident's name. 4. A Victoza pen, identified by staff 1 as belonging to resident 10, was not labeled with the resident's name.
Plan of Correction:	1. The medications for residents 3, 8, and 10 were labeled with the residents name. The medication for resident 3 without label/box was disposed of. 2. Weekly medication cart audits will be conducted for medication labeling compliance. The pharmacy will continue to conduct monthly medication cart reviews. 3. The ALF Unit Manager and /or designee will be responsible.
Standard #:	22VAC40-73-990-C
Description:	Based on document request and interview, the facility failed to conduct at least once every six months, a practice exercise of the resident emergency plan for all staff currently on duty on each shift. EVIDENCE: 1. The facility had no documentation to support that the practice exercise had been conducted since 2/2019. Management staff confirmed that the practice exercise did not take place in 8/2019 when it was due.
Plan of Correction:	1. The practice exercise of the emergency plan for all staff was completed and documented. 2. The exercise requirements are scheduled and reminders set to ensure bi-annual compliance. 3. The ALF Unit Manager and/or designee will be responsible.