VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Bickford of Chesterfield
11200 W. Huguenot Road
Midlothian, VA 23113
(540) 898-1205

Current Inspector: Angela Rodgers-Reaves (804) 662-9774

Inspection Date:

Complaint Related: No

Violations:

Standard #:	22VAC40-73-640-A
Description:	Based on the review of facility records and interviews conducted the facility failed to ensure that the facility implemented a written plan for medication management. Evidence: A.4=Methods to ensure that each resident's prescription medications and any over-the-counter drugs and supplements ordered for the resident are filled and refilled in a timely manner to avoid missed dosages. Resident #3 For example; the facility?s PRN exception document charting for March and April 2021 revealed that facility registered medication aides documented ?No Supply Notified RNC? seven different times regarding the prescribed medications: Brilanta; Trazodone; Sertraline and Tylenol. A.10= Methods to ensure that staff who are responsible for administering medications are adequately supervised, including periodic direct observation of medication administration. Resident #s 1, 2 and 3 The residents? facility physician?s orders, progress notes documentation and Medication Administration Records (MARs) charting for March and April 2021 revealed numerous times that facility registered medication aides performed as licensed health care professionals and documented that they administered PRN medications to facility residents. A facility registered medication aide documented the multiple times (14) that she alone administered PRN medications to the residents. Facility records submitted for the inspector?s review did not reveal that the registered medication aide ensured that current regulations were adhered to before she administered the PRN medications. On 03/22/2021 facility staff #4 documented that she notified facility licensed health care professional staff that she administered PRN medications to resident #2. During 05/18/2021 telephone interview facility Administrator and the LPN on duty did not demonstrate their understanding of current regulations regarding the administration of PRN medications by registered medication aides Facility staff responsible for administering resident medications and supervising registered medication aides are not adhering to current regulations for Licensed Assisted Living Facilities.
Plan of Correction:	FACILITY RESPONSE "RN coordinator and assistant care coordinator will check medication exception weekly to ensure resident are receiving medication per physician orders. RMA's will be instructed to order medications when resident has a 10 day supply left. Medication management policy will be discussed with all registered medication aides and posted in each medication room. All registered medication aides will complete a 4 hour refresher course. Resident 3 discharge from the facility May 20th, 2021. Registered medication aides will be provided training on proper administration and documentation of PRN medication through in-services"
Standard #:	22VAC40-73-650-B
Description:	Based on the review of facility records and interviews conducted the facility failed to ensure that Physician or other prescriber orders, both written and oral, for administration of all prescription and over-the-counter medications and dietary supplements shall include the name of the resident, the date of the order, the name of the drug, route, dosage, strength, how often medication is to be given, and identify the diagnosis, condition, or specific indications for administering each drug. Evidence: Resident #1 ?Current orders as of March 24, 2021? that was submitted for the inspector?s review revealed a handwritten entry on page 1 of 2 ?Tramadol 50mg QHS PRN but the order does not note the date of the order, route, and does not identify the diagnosis, condition, or specific indications for administering the medication Tramadol.
Plan of Correction:	FACILITY RESPONSE "RN coordinator and assistance care coordinator will review all written physician orders to ensure they meet state regulation guidelines prior to faxing to pharmacy. Any clarification will be sent back to physician. Resident 1Tramadol orders corrected 6/1/21 to meet state regulations"
Standard #:	22VAC40-73-680-D
Description:	Based on the review of facility records and interviews conducted the facility failed to ensure that medications were administered in accordance with the physician's or other prescriber'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: Resident #2 The review of facility records revealed that facility registered medication aide twice assessed and inappropriately administered the ?PRN? medication Quetiapine to resident #2 for Insomnia on 03/20, 21/2021. Resident #3 The resident?s Physician?s Orders noted to be current as of 03/01/2021 that was submitted for the inspector?s review revealed three different orders for the medication Trazodone: -Order #1-original date of order and date order written: 02/23/2021. ??Take ? 50mg tablet by mouth every eight hours as needed for severe psychosis or insomnia?. On March 2, 8, 9, 11, 17, 23, 24 and twice on the 30th /2021: Facility registered medication aide documented that she administered one 50mg tablet of the medication Trazodone to resident #3 due to aggressive behaviors or agitation. The documented dosage of one 50mg tablet instead of ? of the 50 mg tablet administered to the resident is against the physician?s order. -Order #2-original date of order and date order written: 04/02/2021 ?Take one 50mg tablet of the medication Trazodone by mouth every day after meals schedule daily at 8:00, 12:00 and 17:00?. The resident?s MAR charting for April 2021 revealed that the medication was not administered to the resident after each meal beginning April 2-13, 2021. Resident physician?s orders and MARs charting for March and April 2021 revealed that facility registered medication aides were operating outside of their skill set: assessing and administering PRN medications: administering PRN medications as scheduled medications; administrating medications and not adhering to the change in dosage; medications were administered without documented diagnosis, registered medication aides were not consistently and inappropriately documenting the administration of prescribed PRN-?as needed? medications.
Plan of Correction:	FACILITY RESPONSE "All registered medication aides will be educated through inserives on proper documentation and procedures for administering all PRN medications. Medication aides will also complete 4 hour refresher course. Resident 3 has been discharge from the facility 5/20/21."
Standard #:	22VAC40-73-680-K
Description:	Based on the review of facility records and interviews conducted the facility failed to ensure that the use of PRN medications is prohibited, unless: The resident is capable of determining when the medication is needed; when the facility has obtained from the resident's physician or other prescriber a detailed medication order that included 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 the symptoms persist. Resident #2 The resident?s physician?s orders charting for March and April 2021 that was submitted for the inspector?s review notes the following-?Oxycod /APSP tablet 7.5-325. Take one table by mouth twice daily as needed for pain ?Max 4GM APAP/24H? ' It is documented on the facility?s medication administration record (PRNs page) charting for March 2021 that was submitted for the inspector?s review that facility registered medication aides administered the medication OXYCOD to resident # 2 ?twenty (20) different times. ' Facility medication administration records (MARs) charting for April 2021 that was submitted for the inspector?s review revealed the following for the medication OXYCOD: 11-7 SHIFT: Two different facility registered medication aides documented that the medication OXYCOD was administered to resident # 2 for pain on eleven (11) different times. 7-3 SHIFT: Facility registered medication aides documented that the medication was administered to resident #2 five different days for the month of April during the 7-3 shift. 3-11 SHIFT: During the month of April 2021, facility registered medication aides documented on the facility?s MAR -Pass Notes document that the medication OXYCOD was administered to resident #2; thirty-eight (38) times beginning 04/01-27/2021. During the 05/14/2021 telephone interview the facility Administrator stated that resident #2 ask for the medication because of pain. However, upon request the facility did not submit for the inspector?s review documentation of the resident?s request for the pain medication OXYCOD on any of the days that the registered medication aides documented that they administered the medication to the resident in March and April 2021. RESIDENT #3- The facility did not submit upon request facility nurses/progress notes or any other facility documentation that the facility?s registered medication aides received written guidance from the resident?s physician prior to administering the 50 mg tablet of the medication Trazodone to the resident.
Plan of Correction:	FACILITY RESPONSE "All registered medication aides will receive proper training on PRN medication administration and documentation. All registered medication will complete 4 hour refresher course. Resident 2 admitted to hospice on 5/21/21 and Oxycodone was scheduled on 5/24/21 by hospice for 9am and 9pm."
Standard #:	22VAC40-73-710-A
Description:	Based on the review of facility records and interviews conducted the facility failed to ensure that the use of chemical restraints were prohibited. Resident #2 -Documented date of admission 01/14/2019 The facility?s March and April 2021 physician?s order that was submitted for the inspector?s review via a fax on 05/14/2021 notes for the medication (1)-QUETIAPINE-Tab 25MG: Take ? tablet 12.5MG by mouth twice daily as needed or Severe Psychosis (Paranoia, Hallucinations and/or Delusion) or Agitation; (2)- -?Oxycod /APSP tablet 7.5-325. Take one table by mouth twice daily as needed for pain ?Max 4GM APAP/24H? Facility registered medication aides documented on the March and April 2021 MAR-Pass Notes document that the medications Quetiapine and OXYCOD were administered to resident #2 on the following days and the reason why: ? 03/20/2021 at 9:28 p.m. facility registered medication aide documented that she administered one 7.5-325mg tablet of the medication Oxycod to the resident for pain. The same registered medication aide also documented that she administered one 25mg tablet of the medication Quetiapine to the resident at this same time for Insomnia; the medication is prescribed for severe psychosis. The registered medication aide over medicated the resident by administering 25mg instead of ? of the 25mg as prescribed by the physician. The registered medication aide also administered the PRN medications to resident #2 without written instructions from the prescribing physician prior to administration ? The next day; 03/21/2021 and again during the 3-11 shift the same registered medication aide noted at 8: 15 p.m. that she administered one 7.5-325mg tablet of the medication Oxycod to the resident for pain. The same registered medication aide also documented that she administered one 25mg tablet of the medication Quetiapine to the resident at this same time again for Insomnia. ? 04/04/2021 at 7:20 p.m. facility registered medication aide documented that she administered one 7.5-325mg tablet of the medication Oxycod to the resident for pain. The same registered medication aide also documented that she administered one 25mg tablet of the medication Quetiapine to the resident at this same time for Insomnia. ? 04/23/2021 at 7:40 p.m. facility registered medication aide documented that she administered one 25mg tablet of the medication Quetiapine to resident #2 for Pain; the medication is prescribed for severe psychosis. ? The review of the facility?s MARs and physician?s orders charting for April 2021 revealed that facility staff #4 over medicated resident #2 approximately fourteen (14) times when she administered one-25mg tablet of the PRN medication Quetiapine instead of ? a tablet of the 25mg PRN medication. Upon request the facility submitted no documentation of any observed or assessed behaviors of the resident exhibiting severe psychosis; requesting pain medication or whether attempts were taken to avoid the chemical restraint, and whether alternatives were used instead.
Plan of Correction:	FACILITY RESPONSE "All registered medication aides will complete a 4 hour refresher course along with a in-services on proper documentation and proper administration of PRN medications to meet state regulations."