VIRGINIA DEPARTMENT OF SOCIAL SERVICES

The Harmony Collection at Roanoke Memory Care
4414 Pheasant Ridge Road
Roanoke, VA 24014
(540) 685-4900

Current Inspector: Holly Copeland (540) 309-5982

Inspection Date: June 9, 2021

Complaint Related: No

Areas Reviewed:

INSPECTION SUMMARY This inspection was conducted by licensing staff using an alternate remote protocol, necessary due to a state of emergency health pandemic declared by the Governor of Virginia. A monitoring inspection was initiated on 6/9/2021 and concluded on 7/8/2021. A self-reported incident was received by the department regarding allegations in the areas of resident care. The administrator was contacted by telephone to conduct the investigation. The licensing inspector emailed the administrator a list of documentation required to complete the investigation. The evidence gathered during the investigation did not support the self-report of non-compliance with standards or law.

Violations:

Standard #:	22VAC40-73-320-A
Description:	Based on record review, the facility failed to ensure that within the 30 days preceding admission, a person shall have a physical examination by an independent physician. EVIDENCE: 1. The admission physical examination form for resident 1 that was completed on 4/13/2021; however, the resident?s physical admission to the facility was dated 5/14/2021.
Plan of Correction:	The Executive Director/Designee will ensure that H&P time frames will be reviewed prior to admission to ensure compliance.
Standard #:	22VAC40-73-450-C
Description:	Based on record review, the facility failed to ensure that the comprehensive individualized service plan shall include a description of identified needs based upon sources including: the Uniform Assessment Instrument (UAI); admission physical examination; interview with resident; fall risk rating, if appropriate; assessment of psychological, behavioral, and emotional functioning, if appropriate; and other sources. EVIDENCE: 1. The admission physical examination form, dated 4/13/2021, indicated that resident 1 had the following allergies and reactions: Accutane (nausea), Ambien (weakness), Cafergot (nausea), Cefpodoxime (stomach pain), Epinephrine (nausea), Ergastatone tartrate (Dizziness), Ergotamine (nausea), Erythrocin Guafenesin (Dizziness & Drowsiness), Erythromycin (nausea), Isotretnoin (nausea), Metronidozole (nausea), Mirtazapine (nausea), Nabumetone (nausea & stomach pain), Relafen (nausea), Restoril, Tenarzepam (Drowsiness & Dizziness), Zolpidem (drowsiness); however, the ISP for resident 1, dated 5/16/2021, indicated that the resident was allergic to Ambien.
Plan of Correction:	The Healthcare Director/Designee will ensure that ISPs will be reviewed for accuracy prior to filing in a resident's chart.
Standard #:	22VAC40-73-930-D
Description:	Based on record review, the facility failed to ensure that for each resident with an inability to use the signaling device, in addition to any other services, the individualized service plan shall specify a minimal frequency of daily rounds to be made by direct care staff to monitor for emergencies or other unanticipated resident needs and the facility shall document the rounds that are made. EVIDENCE: 1. The ISP for resident 1, dated 5/16/2021, indicated that the resident was unable to use the call bell appropriately and that staff will perform frequent checks for safety and incontinence needs; however, the ISP contained no specified frequency of daily rounds. 2. The two hour round check log for resident 1 was not completed on 5/16/2021 at 8:00 PM and 10:00 PM.
Plan of Correction:	The designated Supervisor in Charge/Designee will ensure that round sheets will be reviewed on each shift for accuracy.