VIRGINIA DEPARTMENT OF SOCIAL SERVICES

The Harmony Collection at Roanoke Independent Living
4428 Pheasant Ridge Road
Roanoke, VA 24014
(540) 400-6482

Current Inspector: Holly Copeland (540) 309-5982

Inspection Date: Jan. 13, 2020

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 SANCTIONS.

Comments:

On 1/13/2020 three inspectors, supervised by the Licensing Administrator, conducted a renewal study (8:30AM to 2:20PM). 98 residents were in care. Ten resident records and five staff records were fully reviewed. Several other resident records were partially reviewed. New staff not included in the full record review had background documentation checked. Residents and staff were interviewed, two medication passes were observed. A physical plant tour was done. During the inspection and at the exit interview, the facility was given the opportunity to discuss the violations and to show that they were in compliance. 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 #:	22VAC40-73-210-B
Description:	Based on a review of staff records, the facility failed to ensure that a direct care staff received at least 18 hours of annual training. EVIDENCE: 1. The record for staff 3, hired 11/26/2016, included documentation of only 13 hours of annual training for the period 11/26/2018- 11/25/2019.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-220-B
Description:	Based on record review, the facility failed to ensure that private duty personnel, who are not employees of a licensed home care organization, met all requirements of this standard prior to initiating companion services. EVIDENCE: 1. Facility documentation shows residents 7 and 11 receive private duty companion services, provided by private duty staff 1. The record for private duty staff 1 contained a signed copy of the Private Duty Sitter Program Policy/Procedure and the Private Sitter?s contact information. The facility failed to: ensure the private duty staff is qualified for the type of companion services they are responsible for providing to the residents; maintain documentation of those qualifications; document that a criminal record report was reviewed; and maintain the criminal record report at the facility.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-240-F
Description:	Based on record review, the facility failed to ensure that prior to beginning volunteer service, all volunteers attended an orientation including information on their duties and responsibilities, resident rights, emergency procedures, infection control, and reporting requirements; and failed to ensure the volunteers signed and dated a statement that they have received and understand this information. EVIDENCE: 1. The facility provided two volunteer records for review. The records for volunteers 1 and 2 contained only the Harmony Independent Living Volunteer Application. There was no signed and dated statement that they received the required orientation and understand the information.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-260-A
Description:	Based on review of resident record, the facility failed to ensure that a direct care staff received certification in first aid within 60 days of employment. EVIDENCE: 1. Staff 1 was hired on 6/10/2019. As of the date of inspection, staff had not received certification in SFA (first aid).
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-270-1
Description:	Based on a review of records, the facility failed to ensure that direct care staff received training in methods of dealing with aggressive residents prior to being involved in the care of such residents. EVIDENCE: 1. Interview with staff 18 and review of the records for staff 1, 2, and 3 revealed these direct care staff have not had training in methods of dealing with aggressive residents. A review of the record for resident 11 shows the resident displays aggressive behaviors.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-310-B
Description:	Based on record review, the facility failed to ensure that an interview was conducted and documented between the administrator or a designee responsible for admission and retention decisions, the individual, and his legal representative, if any. EVIDENCE: The record for resident 1 did not contain a documented interview between the facility administrator or a designee responsible for admission and the individual or legal representative.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-310-D
Description:	Based on record review, the facility failed to ensure that the administrator shall provide written assurance to the resident that the facility has the appropriate license to meet his care needs at the time of admission. EVIDENCE: The record for resident 1 did not contain written assurance documentation.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-410-A
Description:	Based on record review, the facility failed to ensure that an orientation to the facility is provided for new residents and their legal representatives. EVIDENCE: The record for resident 1 did not contain documentation of new resident orientation.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-430-H-1
Description:	Based on document review, the facility failed to have some required information on a resident's Discharge Notification and Statement. EVIDENCE: 1. The Discharge Notification and Statement for resident 4 was not completely filled out with required information.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-440-A
Description:	Based on record review and interviews, the facility failed to ensure that the Uniform Assessment Instrument (UAI) is completed whenever there is a significant change in the resident?s condition. EVIDENCE: 1. The record for resident 2 contained a UAI which indicated that resident 2 needs human physical assistance for stairclimbing; however, the Individualized Service Plan (ISP) indicated that resident 2 needs mechanical assistance and human supervision when stairclimbing. Upon interviewing staff 19, it was verified that the ISP correctly reflects the abilities of resident 2. 2. The ISP for resident 5 was updated on 11/07/2019 that resident 5 ?no longer ambulates?. The UAI for resident 5 had last been updated on 04/30/2019 and shows that resident 5 needs mechanical and human help with walking. Staff 18 and staff 19 stated that resident is no longer able to ambulate/walk and uses a wheelchair. The UAI had not been updated to address the significant change in the resident?s condition. 3. The UAI for resident 7 shows this resident does not perform wheeling or stairclimbing, and that no help is required. The ISP shows that the resident would have mechanical and human assistance with physical assistance for stairclimbing, and that a wheelchair is not used at this time. Staff interview reveals that resident 7 needs no assistance with wheeling and needs mechanical and human assistance with physical assistance for stairclimbing.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-440-L
Description:	Based on record review, the facility failed to ensure that the Uniform Assessment Instrument (UAI) was maintained in the resident?s record. EVIDENCE: 1. The record for resident 3 did not contain the UAI.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-450-C
Description:	Based on record review, the facility failed to ensure that the ISP accurately reflected the needs of the resident as indicated on the UAI. EVIDENCE: 1. The UAI for resident 2 indicated that the resident self-administers medication; however, the ISP indicated that resident 2 self-administers medication, but that service is provided by nursing staff. Upon interviewing staff 19, it was determined that resident does self-administer medication without the assistance of nursing staff. 2. The ISP for resident 7 shows that this resident has allergies to Ciprofloxacin, Macrobid, and Codeine; however, the services to be given regarding these allergies are not addressed. The Uniform Assessment Instrument (UAI) for resident 7 shows this resident requires mechanical assistance when transferring, and this is not addressed on the ISP. The ISP for resident 7 shows two entries related to the resident being a fall risk. One shows a fall risk rating of 13, and no services to be provided. The other entry shows a fall risk of 14 and the service described is that the resident will call for assistance. The services from staff are not addressed.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-450-D
Description:	Based on document review, the facility failed to clearly show what hospice services are provided for a resident on the Individualized Service Plan (ISP). EVIDENCE: 1. The ISP for resident 7 shows that this resident receives hospice services, but the services are not specified.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-450-G
Description:	Based on record review, the facility failed to ensure that the ISP was maintained in the resident?s record. EVIDENCE: 1. The record for resident 3 did not contain the ISP.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-550-G
Description:	Based on resident record review, the facility failed to ensure that the rights and responsibilities of residents in assisted living facilities were reviewed annually with each resident or his legal representative or responsible individual. EVIDENCE: 1. The record for resident 8 (date of admission 05/13/2014) documented the last residents? rights review as 10/10/2018.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-640-A
Description:	Based on review of resident records, the facility failed to implement their medication management plan?s methods to ensure that each resident?s prescription medications are filled and refilled in a timely manner to avoid missed dosages. EVIDENCE: 1. The record for resident 11 contained a signed physician?s order, dated 11/21/2019, for escitalopram 5 mg after dinner. The January 2020 medication administration record (MAR) for resident 11 shows the resident missed this medication on January 8, 10, and 11, as it was not available/not delivered from pharmacy. Page 5 of the facility?s medication management plan shows the nurses and RMAs shall be responsible for the timely ordering, and re-ordering of medications so that there are no missed doses or interruptions in the medications being administered.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-990-C
Description:	Based on review, the facility failed to ensure that at least once every six months, all staff currently on duty on each shift shall participate in an exercise in which the procedures for resident emergencies are practiced. EVIDENCE: 1. The facility?s documentation indicated that the last practice exercise for resident emergencies occurred on 11/9/2018.
Plan of Correction:	Not available online. Contact Inspector for more information.