VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Brighter Living Assisted Living and Memory Care
5301 Plaza Drive
Hopewell, VA 23860
(804) 458-5830

Current Inspector: Coy Stevenson (804) 972-4700

Inspection Date: Feb. 24, 2020

Complaint Related: No

Areas Reviewed:

22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES 22VAC40-73 STAFFING AND SUPERVISION 22VAC40-73 ADMISSION, RETENTION, AND DISCHARGE OF RESIDENTS 22VAC40-73 RESIDENT CARE AND RELATED SERVICES

Comments:

A Representative with the Division of Licensing conducted an unannounced, non-mandated inspection on 02-24-2020 from approximately 11:25am to 3:25pm. At the point of entrance the facility administrator was available and on-site. The inspection was in reference to a facility reported incident as well as to follow up on previously cited B2 violations. Areas of non-compliance are found within this violation notice. Please compete the "plan for correction" and "date to be corrected" for each violation cited on the violation notice and return to me within 10 calendar days from today. You will need to specify how the deficient practice will be or has been corrected. Your plan of correction must contain: 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 preventative. Pleases contact the Licensing Inspector Kimberly Rodriguez at 757-586-4004 or by email at kimberly.rodriguez@dss.virginia.gov for additional questions or concerns.

Violations:

Standard #:	22VAC40-73-40-A
Description:	Based on resident record review the licensee failed to ensure compliance with all regulations for licensed assisted living facilities and terms of the license issued by the department and with the facility's own policies and procedures. Evidence #1: On 02/24/2020 record review with staff #1 and #2, documentation on the facility charting notes dated 11-06-2019 with time recorded at 1:55am and 2:10am regarding resident #1's fall reads, "Resident began to C/O neck pain and shoulder pain 10 mins after resident was put back in bed. Resident was re-positioned in bed to prevent further falling." At recorded time of 1:08pm on 11-06-2019 the facility charting notes reads, "writer placed call to outside agency and spoke with outside contact, outside physician's nurse, stated to nurse that resident #1 had a fall last night and is complaining of pain". At recorded time of 2:26pm and 2:30pm the facility charting notes reads, "resident has seem to be in discomfort today resident #1 has been complaining about resident #1's back hurting and resident #1's left arm". At recorded time of 5:41pm charting note reads, "POA called facility and spoke with writer notifying writer that resident #1 had a bruise on left shoulder. Writer stated that writer will get facility staff to go asses resident #1, facility staff went to asses resident #1, resident #1 didn't complain of no pain when touching area." Evidence #2: Based on the facility medical emergency documentation provided by staff #1 and 2 reads, "If a resident is in medical distress, you should take the following steps as quickly as possible: 1. The staff member-in-charge shall conduct an assessment of the resident's condition immediately. The LPN or staff member-in-charge should make any appropriate phone calls (911, resident's physician, responsible party, poison control, District 19 (Adult Protective Services) etc.) 2. Examine resident for injuries. 6. If the resident complains of pain, contact the LPN to assess the resident. If the LPN is not present, contact the emergency crew to assess the resident." Evidence #3: Statement provided by staff #1 and #2 and facility staff schedule for the 11-7pm shift on 11-05-2019 staff working the shift was not Licensed Practice Nurse's.
Plan of Correction:	Licensee will ensure compliance with all regulations for licensed assisted living facilities and terms of the license issued by the department with the facility's own policies and procedures. Inservice re-education on facility's policies and procedures have been provided to staff by Director of Nursing and Resident Care Coordinator. During initial new hire orientation the Director of Nursing will provide training to our direct care staff and when needed and annually.
Standard #:	22VAC40-73-450-C
Description:	(2, 3, 4) Based on resident record review and staff interviews the facility failed to ensure the comprehensive individualized service plan included a description of identified needs, when and where services will be provided, the expected outcome and time frame for expected outcome, date outcome achieved and who will provide services. Evidence #1: Interviews conducted on 02/24/2020 with staff #1, #2 and review of facility discharge notification letter mailed to resident #1's responsible party on 10/31/2019 reads, "We have provided a one on one staff to be with resident #1 until alternative placement can be arranged." However resident #1's individualized service plan dated 12-14-2019 did not address the residents need for one on one staff. Evidence #2: Resident #1's individualized service plan dated 12-14-2019 did not include, when and where services will be provided, the expected outcome and time frame for expected outcome nor did it address who will provide the services needed.
Plan of Correction:	Comprehensive individualized service plan shall include description of identified needs and date identified and the expected outcome and time frame as well as a written description of what service is to be provided and who will be providing the service. Director of Nursing, Resident Care Coordinator and LPN Supervisor conducted audits on 100% of ISP's to ensure accuracy.
Standard #:	22VAC40-73-460-B
Description:	Based on record review the facility failed to ensure care provisions and service delivery shall be resident-centered to the maximum extent possible and include: 2. Personalization of care and services tailored to the resident's circumstances. Evidence #1: On 2/24/2020 record reviewed with staff # and #2, the facility charting notes dates 11-06-2019 reads, "Upon arrival resident was in bed asleep resident had a personal sitter with resident #1 until 11pm" "At approximately 12:55am, RMA supervisor came to get writer from 15 min "brake". When staff entered the room resident was laying in floor on resident #1's fall risk floor mat on resident #1's left side. Evidence #2: The facility charting notes dated 02-08-2020 recorded at 4:21pm reads, "upon arrival, resident was in bed, resident has no aide to sit with resident for entire shift as only two aides were assigned neighborhood one." At approximately 5:45pm another resident witnessed resident #1 on floor and notified aids.**Aide observed that resident was bleeding from back of head.** Staff later received report from residents POA stating that resident #1 was being transferred from one hospital to another hospitals trauma unit. Evidence #3: The facility discharge notification to the residents responsible party on 10-31-2019 documentation reads, "We have provided a one on one staff to be with resident #1 until alternative placement can be arranged". However, based on facility documentation one to one staff was not provided.
Plan of Correction:	Facility staff will ensure care provisions and service delivery shall be resident-centered to the maximum extent possible and shall include personalization of care and services tailored to the resident's circumstances. It will be documented on the ISP as well as the UAI by Director of Nursing and Resident Care Coordinator and LPN Supervisor. ISP and UAI's will be reviewed quarterly by Director of Nursing and Resident Care Coordinator and LPN Supervisor when there are any changes or updates to the ISP and UAI's.
Standard #:	22VAC40-73-680-K
Description:	Based on resident record review, the facility failed to ensure, the use of PRN (as needed) medications is prohibited, unless medication aid administers the PRN medication when the facility has obtained from the resident's physician or other prescriber a detailed medication order. The order shall include symptoms that include the use of the medication, exact dosage, the exact time frames the medication is to be given in a 24-hour period, and directions as to what to do if symptoms persist. Evidence #1: One 02/24/2020 with staff #1 and #2, the facility charting notes reads, "Resident was also given a PRN med by other RMA supervisor for resident #1's pain". Based on statement of staff #1 and #2 and facility nursing schedule for the 11-7 shift, the facility RMA supervisor was staff #3 hired as a facility registered medication aide. Evidence #2: The facility medication administration record for the month of November 2019, documents resident #1 was administered "Acetaminophen 500MG, Take one tablet (500MG) by mouth four times a day as needed **Not FCP**. The medication administration record evidences "3X" the medication was administered to resident #1. Evidence #3: Resident #1's medication order signed by resident #1's physician on 9-23-2019 states, Acetaminophen Extra Strength 500 mg tablet "1 tab orally four times daily as needed".
Plan of Correction:	Facility staff will ensure the use of PRN (as needed) medication is prohibited unless medication aid administers the PRN medication with a detailed order from the resident's physician or other prescriber a detailed medication order. The order shall include symptoms that indicate the use of the medication, exact dosage, the exact time frames the medication is to be given in a 24-hour period and directions as to what to do if symptoms persist. Director of Nursing, Resident Care Coordinator and LPN Supervisor conducted 100% audit on PRN orders and obtained detailed PRN medication orders for every resident.