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: Sept. 8, 2022

Complaint Related: No

Areas Reviewed:

22VAC40-73 GENERAL PROVISIONS 22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES 22VAC40-73 PERSONNEL 22VAC40-73 STAFFING AND SUPERVISION 22VAC40-73 ADMISSION, RETENTION AND DISCHARGE OF RESIDENTS 22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-73 RESIDENT ACCOMMODATIONS AND RELATED PROVISIONS 22VAC40-73 BUILDINGS AND GROUND 22VAC40-73 EMERGENCY PREPAREDNESS 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS 22VAC40-90 THE SWORN STATEMENT OR AFFIRMATION 22VAC40-90 THE CRIMINAL HISTORY RECORD REPORT

Technical Assistance:

1120-B

Comments:

Type of inspection: Monitoring Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 09/08/2022 at 09:00 AM ? 01:00 PM 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 Holly Copeland, Licensing Inspector at 540-309-5982 or by email at holly.copeland@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-1070-B
Description:	Based on observation, the facility failed to ensure that when there are indications that ordinary materials or objects may be harmful to a resident with a serious cognitive impairment, these materials or objects shall be inaccessible to the resident except under staff supervision. EVIDENCE: While completing a physical plant walk-through at 09:40 AM on the date of inspection, LI observed a housekeeping cart that was stationary around the corner from the rehab room which contained scissors and skin cream in an unlocked storage box on the side of the cart.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-450-C
Description:	Based on record review, the facility failed to ensure that the comprehensive individualized service plan (ISP) shall include all identified needs. EVIDENCE: 1. The record for resident 1, admitted 05/23/2022, contained a signed physician?s diet order, dated 05/24/2022, which indicated that resident 1 requires a diet with puree consistency. The record for resident 1 also contained a signed physician?s diet order, dated 06/03/2022, which indicated that resident 1 requires a diet with mechanical soft consistency. Both diet orders indicated that the resident has the following food allergies: mammalian meat, beef, pork, rabbit, lamb, venison, gelatin, cow?s milk, and milk products. 2. The record for resident 1 contained a signed Durable Do Not Resuscitate Order form, dated 05/24/2022, and a signed Durable Power of Attorney, dated 11/27/2018. 3. The record for resident 1 contained signed orders to discontinue occupational therapy (OT) and physical therapy (PT), effective 07/15/2022, and to discontinue speech therapy (ST), effective 06/18/2022. 4. The ISP for resident 1, dated 05/26/2022, did not contain documentation of resident 1 special diet, allergies, DNR status, POA information, nor OT/PT/ST services start and stop dates.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-450-E
Description:	Based on record review, the facility failed to ensure that the individualized service plan (ISP) shall be signed and dated by the licensee, administrator, or his designee, and by the resident or his legal representative. EVIDENCE: The ISP for resident 1, dated 05/26/2022, was not submitted for the resident?s responsible party to sign until 08/31/2022, and a signature was still not obtained as of the date of inspection.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-610-B
Description:	Based on observation, the facility failed to ensure that menus for meals and snacks for the current week shall be dated and posted in an area conspicuous to residents. EVIDENCE: While completing a physical plant walk-through at 09:54 AM on the date of inspection, LI observed that the only weekly menu found that was posted for residents was difficult to read due to small font size, was dated May 8 ? 14 2022, and was hanging in a locked case on the wall which was difficult to reach.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-930-D
Description:	Based on record review, the facility failed to ensure that for each resident with an ability to use a signaling device that daily rounds shall be made and documented as specified by the resident?s individualized service plan (ISP). EVIDENCE: 1. The ISPs for residents 2, 3, and 4 indicate the residents? inability to use a signaling device and will have two-hour rounds performed to monitor for emergencies or other unanticipated needs. 2. A review of a sample of the TWO HOUR ROUND CHECK LOG for resident 2 did not contain entries for the following dates and times: On 08/03/2022 from 08:00 AM through 2:00 PM; on 08/05/2022 at 08:00 PM and 10:00 PM; and on 08/06/2022 from 12:00 AM through 06:00 AM. 3. A review of a sample of the TWO HOUR ROUND CHECK LOG for resident 3 did not contain entries for the following dates and times: On 08/06/2022 from 12:00 AM through 06:00 AM. 4. A review of a sample of the TWO HOUR ROUND CHECK LOG for resident 4 did not contain entries for the following dates and times: On 08/08/2022 from 4:00 PM through 10:00 PM.
Plan of Correction:	Not available online. Contact Inspector for more information.