VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Williams Luv N Care Home
4012 Elmswell Drive
Richmond, VA 23223
(804) 222-4752

Current Inspector: Shelby Haskins (804) 305-4876

Inspection Date: Nov. 22, 2021

Complaint Related: No

Areas Reviewed:

22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES 22VAC40-73 ADMISSION, RETENTION, AND DISCHARGE OF RESIDENTS 22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-90 The Sworn Statement or Affirmation

Comments:

A renewal inspection was conducted by a Licensing Inspector on November 22, 2021 from 12:38 p.m. ? 4:22 p.m. There were 8 residents in care. During the inspection, the following was completed: Review of 4 resident and 4 staff records, facility tour of building and grounds, review emergency food and water supplies, tour resident rooms, resident interview, reviewed monthly activity calendar and menus, fire inspection and healthcare oversight, tested water temperatures, and medication pass observation. The potential findings were reviewed with the Administrator. Additional information requested and opportunity was given to present additional information.

Violations:

Standard #:	22VAC40-73-40-B-4
Description:	Based on a tour of the physical plant with the licensee, the facility failed to ensure that it acted in accordance with General Procedures and Information for Licensure (22VAC40-80-120) terms of the license. Evidence: 1. 22VAC40-80-120-D notes, ?Prior to changes in operation that would affect the terms of the license, the licensee shall secure a modification to the terms of the license from the department. 2. During the tour of the physical plant on 11-22-2021, the license showed the inspector rooms 6, 7, 8, and 9. Each room had a resident and their belongings in it. 3. The licensee provided a roster via email on 11-30-2021 noting that Resident #5 resides in room 6, Resident #6 resides in room 7, Resident #7 resides in room 8, and Resident #8 resides in room 9. 4. A request for modification of license to use an unlicensed portion of the physical plant for residents was not submitted to the department.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-400
Description:	Based on record review and interview with staff, the facility failed to provide to each resident or the resident?s legal representative, a monthly statement that itemizes any charges made by the facility and any payments received from the resident or on behalf of the resident during the previous calendar months and show the balance due or any credits for overpayment. The facility shall also place a copy of the monthly statement in the resident's record. Evidence: 1. Review of Resident #1 ? Resident #4?s records did not show monthly accounting statements as required. 2. Staff #1 confirmed monthly statements for each resident were not provided as Staff #1 stated ?I don?t deal with anyone?s money.?
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-650-E
Description:	Based on record review and interview with staff, the facility failed to ensure the resident's record contained the physician's signed written order or a dated notation of the physician's or other prescriber's oral order. Evidence: 1. Licensing inspector requested the following physician?s signed written orders or oral order for residents? record review: a. Resident #1: Furosemide 20 mg, Gabapentin 100 mg, Lisinopril 20 mg, Natural Fiber Laxative, Omeprazole 40 mg, Trazodone 150 mg, Benzonatate 100 mg, Diclofenac Sodium Gel, Tramadol 50 mg, and Tizanidine 2 mg; b. Resident #2: Discontinue order Pharbetol 500 mg; c. Resident #3: 3 Xcopri prescriptions (for 12.5-25 mg 200 mg and 150-200 mg), Divalproex ER 250 mg, and his Vimpat 150 mg; and d. Resident #4: Discontinue order Bupropion 200 mg. 2. Regarding Resident #2, Staff #1 wrote, ?[Resident #2] doesn?t have Pharbetol 500 mg on [Resident #2?s] medication record, Drug Regimen or [Resident #2?s] Physician?s orders. However, if [Resident #2] was on it, I would staple the discontinue notice to [Resident #2?s] physician?s orders and keep?; however, Resident #2?s physician?s orders electronically signed by [Physician #2] on 8-27-2021 documented, ?Pharbetol 500 mg as needed every 6 hours?. 3. Regarding Resident #4, Staff #1 wrote, ?[Resident #4] doesn?t have Bupropion 200 mg anywhere on [Resident #4?s] physician?s orders but [Staff #1] did ask [Resident #4] ? used to take it before [Resident #4] moved here??; however, Resident #4?s 3-19-2020 physician?s summary signed by [Physician #1] documented Bupropion 200 mg twice daily. 4. Staff #1 confirmed the facility failed to ensure the resident's record contained the physician's orders for Resident #1 - #4, as Staff #1 wrote, ?The original signed prescriptions from physicians are sent straight to [Pharmacy #1] from their doctor. The residents never bring them home with them.?
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-90-30-C
Description:	Based on record review and interview with staff, any person making a materially false statement on the sworn statement or affirmation shall be guilty of a Class 1 misdemeanor. Evidence: 1. Staff #3? sworn statement or affirmation answered ?No? to the question, ?Have you ever been convicted of a law violation(s) but excluding offenses committed before your eighteenth birthday that were finally adjudicated in a juvenile court or under a youth offender law??; however, Staff #3 had convictions on the Virginia Criminal Record. 2. Staff #2 confirmed the information was filled out incorrectly and was a false statement.
Plan of Correction:	Not available online. Contact Inspector for more information.