VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Hilton Plaza, Inc.
311 Main Street
Newport news, VA 23601
(757) 596-6010

Current Inspector: Willie Barnes (757) 439-6815

Inspection Date: June 28, 2022 , July 5, 2022 and July 12, 2022

Complaint Related: No

Areas Reviewed:

22VAC40-73 PERSONNEL 22VAC40-73 ADMISSION, RETENTION AND DISCHARGE OF RESIDENTS 22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-73 BUILDINGS AND GROUND 22VAC40-73 EMERGENCY PREPAREDNESS 22VAC40-90 THE CRIMINAL HISTORY RECORD REPORT

Comments:

Type of inspection: Renewal An unannounced on-site renewal inspection was conducted by two inspectors from the Peninsula Licensing Office on 6-28-22 (AR 07:10 a.m./dep 2:30 p.m.) The facility census was 62. A tour of the facility was conducted, emergency preparedness standards were reviewed and observed, first aid kit check, breakfast meal observed, medication pass observation conducted, staff and resident interviews and records were reviewed. An exit meeting was conducted with the administrator in charge. The Acknowledgement of Inspection form was sent via email for the Administrator to review and sign on 6-23-22.The final exit meeting will be conducted on 7-22.22. The evidence gathered during the inspection determined non-compliance with applicable standard(s) or law, and violation(s) were documented on the violation notice issued to the facility. The licensee has the opportunity to submit a plan of correction to indicate how the cited violation(s) will be addressed in order to return the facility to compliance and maintain future compliance with applicable standard(s) or law. If the licensee wishes to provide a plan of correction: (i) type the plan on a separate Word document, (ii) identify the standard violation number being addressed, (iii) include the date the violation will be corrected, (IV) do not include any names or confidential information, and (V) return to the licensing inspector by email within five (5) business days of the exit interview. Compliance with all applicable regulations and law shall be maintained and any areas of noncompliance must be corrected. Within 15 calendar days of your receipt of the inspection findings (inspection summary, violation notice, and supplemental information), you may request a review and discussion of these findings with the inspector's immediate supervisor. To make a request for review and discussion, you must contact the licensing supervisor at the regional licensing office that serves your geographical area. Regardless of whether a supervisory review has been requested, the results of the inspection will be posted to the DSS public website within 5 business days of your receipt of the Inspection Summary and/ or Violation Notice. The department's inspection findings are subject to public disclosure. Please Note: A copy of the findings of the most recent inspection are required to be posted on the premises of the facility For more information about the VDSS Licensing Programs, please visit: www.dss.virginia.gov Should you have any questions, please contact Willie Barnes, Licensing Inspector at 757-439-6815 or by email at willie.barnes@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-210-B
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure direct care staff attended at least 18 hours of training annually. Evidence: 1. On 6-28-22, staff #2?s record documented 5 of the required 18 hours of training. There was not documentation of the required 4 hours of mental health training. Staff?s date of hire documented as 10-1-20. 2. Staff #5?s record documented 7 of the required 18 hours of training. There was no documentation of the required 4 hours of mental health training. Staff?s date of hire documented as 5-19-21. 3. On 6-28-22 and 7-12-22, staff #1 acknowledged the aforementioned staff records did not have the required annual training hours.
Plan of Correction:	Administrator will require twice weekly hour-long training until each direct care staff member is caught up.
Standard #:	22VAC40-73-250-D
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure a staff person within seven days prior to the first day of work at the facility submitted the results of a risk assessment, documenting the absence of tuberculosis (TB) in a communicable form as evidenced by the completion of the current screening form published by the Virginia Department of Health or a form consistent with it. Evidence: 1. On 6-28-22, staff #3?s record documented staff?s TB was dated 9-8-21. Staff?s record noted a date of hire of 6-2-22. 2. On 6-28-22 and 7-12-22, staff #1 acknowledged the aforementioned staff?s TB was not within seven days prior to the first day of work.
Plan of Correction:	Administrator going forward will ensure all staff beginning their new position will have a negative TB test provided prior to the start date.
Standard #:	22VAC40-73-310-B
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure it documented the interview between the administrator or a designee responsible for admission and retention decisions, the individual, and the legal representative, if any. In some cases, conditions may create special circumstances that make it necessary to hold the interview on the date of admission. Evidence: 1. On 6-28-22, residents? # 1, #2, and #3?s record did not included documentation of an interview and the date of the interview. The residents? date of admission documented as 1-25-22. 2. On 6-28-22 and 7-12-22, staff #1 acknowledged the aforementioned residents? records did not included a documented and dated interview.
Plan of Correction:	Staff interviewing prospective resident will ensure that documentation of the interview will be stored as a matter of record prior to the date of actual admission
Standard #:	22VAC40-73-310-D
Description:	Based on record reviewed and staff interview, the facility failed to ensure the administrator provided written assurance to the resident that the facility had the appropriate license to meet the care needs at the time of admission. Evidence: 1. On 6-28-22, residents, #1, #2, and #3?s included a copy of the written assurance, however, the document was not signed and dated by the facility representative. 2. On 6-28-22 and 7-12-22, staff #1 acknowledged the aforementioned resident?s record did not include a signed and dated written assurance.
Plan of Correction:	Staff will ensure that a signed and dated written assurance is put into the resident prior to admission.
Standard #:	22VAC40-73-320-A
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure a person shall have a physical examination by an independent physician within 30 days preceding admission and include the results of a risk assessment documenting the absence of tuberculosis (TB) in a communicable form as evidenced by the completion of the current screening form published by the Virginia Department of Health or a form consistent with it. Evidence: 1. On 6-28-22, resident #1 and #2?s physical examination and TB document in the record was dated 3-25-21. The residents? date of admission was documented as 1-25-22. 2. Resident #3?s physical examination and TB in the record was dated 3-4-21. The resident?s date of admission was documented as 1-25-22. 3. On 6-28-22 and 7-12-22, staff #1 acknowledged the aforementioned resident?s physicals and TBs were not within 30 days of admission.
Plan of Correction:	Staff will ensure that a physical exam and negative TB test result will be documented within 30 days preceding admission.
Standard #:	22VAC40-73-380-B
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure the personal and social information document was kept current. Evidence: 1. On 6-28-22, resident #1, #2, and #3?s personal and social information form in the residents? record was not completed, the form was blank. 2. On 6-28-22 and 7-11-22, staff #1 acknowledged the aforementioned residents? personal and social information was not completed.
Plan of Correction:	Staff will ensure that the personal and social information is documented and kept current.
Standard #:	22VAC40-73-390-B
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure the resident agreement/acknowledgement was signed and dated. Evidence: 1. On 6-28-22, resident #1, #2 and #3?s resident agreement/acknowledgement form in the record was not signed and dated by the facility. 2. On 6-28-22 and 7-12-22, staff #1 acknowledged the aforementioned residents? agreement/acknowledgement form was not signed and dated by the facility.
Plan of Correction:	Staff will ensure that the resident agreement/acknowledgement will be signed and dated upon admission going forward.
Standard #:	22VAC40-73-410-A
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure upon admission, it would provide an orientation for new residents and their legal representatives. Acknowledgement of having received the orientation shall be signed and dated by the resident and, as appropriate, his legal representative, and such documentation shall be kept in the resident?s record. Evidence: 1. On 6-28-22, resident #1, #2, #3 and #5?s record did not have documentation of the resident?s orientation to the facility by facility representative, no signature and date of facility provided on document. Residents? #1, #2 and #3 date of admission was documented as 1-25-22. Resident #5?s date of admission was documented as 9-27-19. 2. On 6-28-22 and 7-12-22, staff #1 acknowledged the aforementioned residents? orientation to the facility?s document was not signed and documented by facility representative.
Plan of Correction:	Staff will ensure that a proper orientation is provided, signed and documented in the resident?s record for both the resident and, as appropriate, his legal representative.
Standard #:	22VAC40-73-440-G
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure when a resident moves to an assisted living facility from another assisted living facility or other long-term care setting that use the UAI, the previous assessment is no more than 12 months old. Evidence: 1. On 6-28-22, resident #1?s UAI was dated 9-30-20 and reassessed on 10-7-20. The resident?s date of admission to the facility was documented as 1-25-22. 2. On 6-28-22 and 7-12-22, staff #1 acknowledged the aforementioned resident did not have a UAI that was no more than 12 months upon admission.
Plan of Correction:	Staff will ensure that each resident has a current UAI prior to admission.
Standard #:	22VAC40-73-450-C
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure the comprehensive individualized service plan (ISP) was completed within 30 days and included all assessed needs. Evidence: 1. On 6-28-22, resident #1 and #2?s record did not include an ISP. The residents? date of admission was documented as 1-25-22. 2. On 6-28-22 and 7-12-22, staff #1 acknowledged the aforementioned residents? record did not include an ISP.
Plan of Correction:	Staff will ensure that a comprehensive ISP is completed within 30 days including all assessed needs.
Standard #:	22VAC40-73-450-F
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure the individualized service plan (ISP) shall be reviewed and updated at least once every 12 months and as needed as the condition of the resident changes. Evidence: 1. On 6-28-22, resident #2?s ISP was dated 1-25-22 and had a review date (end date) of 4-22-22. 2. Resident #4?s ISP in the record was dated 6-19-19. 3. Resident #7?s ISP in the record was dated 8-21-20. 4. On 6-28-22 and 7-12-22, staff #1 acknowledged, the aforementioned residents? ISP was not updated at least once every 12 months or when the review period ended.
Plan of Correction:	Staff will ensure that the ISP?s shall be reviewed and updated at least once every 12 mos. as needed.
Standard #:	22VAC40-73-580-A
Description:	Based on document reviewed and staff interviewed, the facility failed to ensure when any portion of the facility is subject to inspection by the Virginia Department of Health, the facility shall be in compliance with those regulation, as evidenced by an annual report from the Virginia Department of Health. Evidence: 1. On 6-28-22, the date of the facility?s last health inspection was dated 2-28-20. 2. Staff #1 acknowledged the facility did not have a current (annual) health inspection.
Plan of Correction:	Facility will work directly with VDH to ensure the facility stays in compliance with the annual inspections and documents the report.
Standard #:	22VAC40-73-610-E
Description:	Based on staff interviewed, the facility failed to ensure a copy of a diet manual containing acceptable practices and standards for nutrition was kept current and readily available to personnel responsible for food preparation. Evidence: 1. On 66-28-22, during an inspection of the facility, staff #7 was not able to provide a copy of a diet manual containing acceptable practices and standards for nutrition readily available to personnel responsible for food preparation. 2. On 6-28-22 and 7-12-22, staff #1 acknowledged the facility did not have a diet manual available.
Plan of Correction:	Food service manager will ensure that a current copy of the diet manual is available for the food prep staff.
Standard #:	22VAC40-73-640-A
Description:	Based on observation, record reviewed, document reviewed, and staff interviewed, the facility failed to implement its medication management plan to ensure a resident?s prescription medication was filled and refilled in a timely manner to avoid missed dosages. Evidence: 1. On 6-28-22, during the medication pass observation with staff #3, resident #1?s 8:00 a.m. prescribed dosage of Paliperidone was not available to administer at 7:34 a.m. 2. Staff #3 and #1 acknowledged the aforementioned resident?s prescribed medication was not available to administer at the prescribed time and day.
Plan of Correction:	Registered Med-Aides will ensure that all prescriptions are filled and refilled to avoid missed dosages.
Standard #:	22VAC40-73-870-A
Description:	Based on observation and staff interviewed, the facility failed to ensure the interior of the building was maintained in good repair and kept clean and free of rubbish. Evidence: 1. On 6-28-22, during a tour of the facility with staff #2, the following was observed in areas of the building: (a) the ceiling vents in resident rooms (108, 210 and 202) contained black substance of some kind; (b) the first floor men?s bathroom (common area)?s sink did not have hot water; (c) the second floor men?s bathroom had large grey substance on the ceiling and the ceiling vent was also covered with a grey substance; (d) the second floor men?s bathroom tub contained brown colored areas; (e) the second floor men?s toilet was inoperable; (f) the second floor men?s bathroom divider was shaky, not stable and rusted and the base; (g) the second floor stairwell door was covered with a brown colored substance and (h) the male and female residents? bedroom floors contained brown and black substance, particularly around the floor baseboards. 2. On 6-28-22, staff #2 acknowledged the building was not kept clean and items were determined to be in need of repair.
Plan of Correction:	Floor supervisor will ensure that the floor staff at the facility keeps the building in good repair, clean and free of any rubbish.
Standard #:	22VAC40-90-40-B
Description:	Based on the employee record review, the facility failed to ensure the criminal history record report was obtained on or prior to the 30th day of employment for each employee. Evidence: 1. On 6-28-22 staff #6?s record documented staff?s date of hire as 9-27-21 and there was no Virginia State Police Criminal history check in the employee file. 2. On 6-28-22 and 7-12-22 #1 acknowledged the file did not contain a Virginia State Police Criminal history check.
Plan of Correction:	Administrator will ensure that no employee starts work until the criminal background history report is obtained prior to the new employee starts work at the facility.