VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Bellaire at Stone Port
1684 Port Hills Drive
Harrisonburg, VA 22801
(540) 246-0888

Current Inspector: Jeffrey Marnien (540) 571-0189

Inspection Date: Sept. 24, 2019

Complaint Related: No

Areas Reviewed:

22VAC40-73 RESIDENT CARE AND RELATED SERVICES

Technical Assistance:

Recommended much more frequent observations and monthly in-services for all registered medication aides/nurses. Discussed the necessity of ensuring the five rights are followed with each and every medication pass and methods to monitor this to ensure compliance.

Comments:

An unannounced non-mandated inspection was conducted on 9/24/19 to review medication administration. Medication administration observations were completed with three residents and medication administration records were reviewed. Interviews were conducted with residents and staff. Non-compliance was found in the area of medication administration. Please complete the columns for "description of action to be taken" and "date to be corrected" for the violation cited on the violation notice, and then return a signed and dated copy to the licensing office with 10 calendar days of receipt. If you have any questions, contact your licensing inspector at (540) 430-9258.

Violations:

Standard #:	22VAC40-73-680-D
Description:	Based upon documentation the facility failed to ensure one of three residents' medications were administered in accordance with the physician's orders and with the standards of practice as outlined in the current registered medication aide curriculum approved by the Virginia Board of Nursing. vidence: 1) Based upon record reviews, medications for resident D, who had not moved in yet, were placed in the wrong medication cart and were found in front of resident C's medications. On 9/16/19, the administrator discovered two pills of Aspirin (81mg), Lexapro (10mg), Claritin (10mg), Preservision (two soft gels), Aricept (5mg), and three pills of Namenda (10mg) were missing from the morning medication cards. 2) On 9/16/19 at 3:52 pm, a signed order was on file to hold resident C's Coumadin for two days. The medication administration record (MAR) indicated resident C was to receive one 3mg tablet at 10:00 pm on Tuesdays, Thursdays and Sundays and one 4mg tablet on Mondays, Wednesdays, Fridays and Saturdays. On 9/18/19 (Friday) at 10:00 pm, the MAR had an "H" in the blank; however, the documentation on the "status given" section indicated the medication was given by staff A on 9/18/19 at 9:40 am.
Plan of Correction:	1) Registered medication aide (RMA) with medication error was removed from passing medications. Medication carts were audited to ensure correct medications were in the correct cart and matched current physician orders. 2) Medication administration education was provided on 10/15/19 to all RMAs and nurses by the health care oversight nurse provided by the facility's contract pharmacy. The training focused on administration of medications in accordance with physicians' instructions. The consultant nurse coordinator conducted medication cart audits and medication administration observations on 10/14/19 and 10/15/19. 3) A process was created to utilize Medication Dashboard in the electronic health record as an audit tool for daily review of medication administration by nursing of as-needed (PRN) medications administered and effectiveness, medications not administered and rationale, potential duplication of medications, and possible refills. The DHW and LPN supervisors will complete medication administration observation audits weekly and medication cart audits monthly. Consultant nurse from the pharmacy will continue with monthly audits for three months and then quarterly. The DHW, along with the consultant nurse and home health nurses, will provide monthly in=services to RMAs/LPNs about proper medication administration protocol to include the five rights. The DHW will ensure compliance with this standard.