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: June 29, 2022 and July 20, 2022

Complaint Related: Yes

Comments:

Type of inspection: Complaint Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 06/29/2022 between the approximate times of 11:57 until 2:00p.m 07/20/2022 between the approximate times of 1:40p.m until4:20p.m The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. A complaint was received by VDSS Division of Licensing on 05/11/2022 regarding allegations in the areas of admission, retention and discharge of residents and resident care and related services. The evidence gathered during the investigation supported some, but not all of the allegations; area(s) of non-compliance with standard(s) or law. A violation notice was issued; any violation(s) not related to the complaint but identified during the course of the investigation can also be found on the violation notice. 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 Angela Rodgers-Reaves, Licensing Inspector at (804)840-0253or by email at angela.r.reaves@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-1180-B
Complaint related:	No
Description:	Based on the review of facility records and interview conducted the facility failed to ensure that when there are indications that ordinary materials or objects may be harmful to a resident, these materials or objects shall be inaccessible to the resident except under staff supervision. Evidence: Resident #1-Documented date of admission 04/15/2022 During a walkthrough and observation of the resident?s room in the safe and secure environment on 06/29/2022 the inspector along with facility staff observed a single pane of glass being stored in the resident?s room.
Plan of Correction:	FACILITY RESPONSE: "All resident rooms in Memory Care had a safety inspection completed by Administrator and Nurse Manager, conducted to ensure any unsafe items are not accessible to any residents in the memory care area. This inspection has been completed as of 8/1/2022."
Standard #:	22VAC40-73-325-B
Complaint related:	No
Description:	Based on the review of facility records and interviews conducted with the facility Administrator and facility staff the facility failed to ensure that a fall risk assessment was conducted after each fall. Evidence: Resident #1 Documented date of admission 04/15/2022 06/09/2022: The facility submitted a self-reported resident incident to the department informing that the resident had a fall with injury that required outside emergency medical intervention. The facility did not submit upon request documentation that a risk assessment was conducted after the resident?s 06/09/2022 fall.
Plan of Correction:	FACILITY RESPONSE: "A Fall Risk Assessment was completed following the fall on 6/9/2022 and dated 6/10/2022. During the visit on 6/9/2022 the fall risk report was not given to the licensing inspector. An audit reviewing of all resident charts was completed by Nurse Manager to ensure fall risk reports are in the correct placement of the resident charts.
Standard #:	22VAC40-73-325-C
Complaint related:	Yes
Description:	Based on the review of facility records and interviews conducted with the facility Administrator and facility staff the facility failed to ensure that should a resident who meets the criteria for assisted living care fall, the facility must show documentation of an analysis of the circumstances of the fall and interventions that were initiated to prevent or reduce risk of subsequent falls. Evidence: Resident #1 Documented date of admission 04/15/2022 Facility records submitted for the inspector?s review noted that the resident had falls on 05/03, 10/2022 and on 06/09/2022. The facility did not submit upon request documentation of an analysis of the circumstances of the fall and interventions that were initiated to prevent or reduce risk of subsequent falls.
Plan of Correction:	FACILITY RESPONSE: "The facility will document analysis of the circumstances of all falls and interventions that are initiated to prevent or reduce risk of falls. This will be reflected in the resident plan of care."
Standard #:	22VAC40-73-330-B
Complaint related:	No
Description:	Based on the review of facility records and interviews conducted the facility failed to ensure that written communication is utilized as a means of keeping direct care staff on all shifts informed of significant happenings or problems experienced by residents, including complaints and incidents or injuries related to physical or mental conditions. Evidence: Resident #1-Documented date of admission 04/15/2022 Facility direct care staff stated during the 06/29/2022 interviews that if I (the inspector) had come a few hours earlier I would have seen an example of the resident?s aggressive and combative behaviors. The direct care staff interviewed provided various examples of the resident?s aggressive behaviors, refusing medications, and getting out of the wheelchair- the communication log however is not documented to note that all of these incidents are being passed on to other shifts.
Plan of Correction:	FACILITY RESPONSE: "Behavior incidents will be documented in the progress notes and recorded in the communication log for each occurrence. An In Service to be held on documentation standards for facility communication log and progress note documentation by Fai Lawton, LPN on August 25th for all staff. "
Standard #:	22VAC40-73-440-F
Complaint related:	No
Description:	Based on interviews conducted with facility staff and the review of facility records the facility failed to ensure that a resident?s UAI was completed within 90 days prior to admission to the assisted living facility. Evidence: Resident #1- Documented date of admission 04/15/2022 Upon request to review the resident?s UAIs the facility submitted a 05/19/2022 UAI that is not signed by the facility Administrator. The facility provided not documented evidence that the resident was assessed using the UAI prior to being admitted to the facility.
Plan of Correction:	FACILITY RESPONSE: "Documented date of admission is 4/15/2022. Resident UAI was completed during assessment at discharging facility and dated 4/15/2022 All UAi?s and ISPs are current and in resident charts. A review was recently completed in June 2022 of all resident charts. A new audit will be completed checking admission dates to ISP dates to ensure compliance. Administrator will review all resident charts by 9/1/2022 to ensure no missing signatures"
Standard #:	22VAC40-73-450-A
Complaint related:	Yes
Description:	Based on the review of facility records and interviews conducted the facility failed to ensure that on or within seven days prior to the day of admission, a preliminary plan of care (ISP) was developed to address the basic needs of the resident that adequately protects his health, safety, and welfare. Evidence: Resident #1- Documented date of admission 04/15/2022 The resident?s 04/12/2022 Physical Examination Report notes in part under the heading: Significant Medical History: ?Moderate protein calorie malnutrition, muscle weakness decreased debility.? Diagnosis or significant problems ?Decreased mobility, Dementia with behavioral disturbances, Protein Calorie malnutrition.? Therapy ?PT/OT/Speech therapy orders placed?. As a follow up of the 06/29/2022 onsite investigation the inspector was also onsite on 07/20/2022 and requested documentation of the resident?s preliminary and comprehensive ISPs. In response the facility Administrator submitted a 04/18/2022 Nurse Assessment document. The 04/18/2022 Nurse Assessment document does not identify that a plan of care had been developed for the resident based on the assessed needs as noted by the resident?s physician.
Plan of Correction:	FACILITY RESPONSE: "Facility Administrator and /or Nurse Manager will ensure that on or within 7 days of admission a preliminary care plan is completed that adequately protects resident health, safety and welfare. "
Standard #:	22VAC40-73-460-C
Complaint related:	Yes
Description:	Based on the review of facility records and interviews conducted with the facility Administrator and facility staff the facility failed to ensure that care was furnished in a way that fosters the independence of each resident and enables him to fulfill his potential. Evidence: Resident #1-Documented date of admission 04/15/2022 Facility Progress Notes document revealed the following: 04/15/2022 the resident was admitted to the facility?s assisted living program with a diagnosis of dementia with behavioral disturbances. 04/26/2022: Resident #1 was moved to the facility?s safe and secure environment due to severe dementia with behavioral disturbances. Facility documentation and staff interviews conducted revealed that the aggressive and combative behaviors continued. The facility Administrator documented on the day of admission that the physician?s orders for physical/occupational and speech therapy were received. However interviews conducted and the review of facility record revealed that therapy services were not obtained for resident #1 until 05/11/2022. Facility medication administration records revealed the resident was not administered multiple dosages of prescribed medications due to the medications not being on site, the resident refused and or spit the medications out: April 2022: Sixteen dosages May 2022: Fifteen dosages June 2022: Eight dosages Facility records submitted for the inspector?s review and interviews conducted revealed that the resident engaged in repeated acts of physical aggression towards staff and verbal arguments with other residents. There were documented incidents that the resident ?smacked, punched and smacked the glasses off of a staff?s face, the resident head butted the facility Administrator, the resident ?swung at staff and started to spit on a staff member, that the resident was yelling throughout the shift, that the resident required two direct care staff to assist with putting on pajamas because the resident was resisting care. Facility staff also documented the multiple times that resident #1 was observed putting herself out of her wheelchair and onto the floor even after staff would place her back in the wheelchair. When staff made attempts to assist the resident back into the wheelchair resident #1 would become physically combative towards staff. Since admission the resident has had three falls with injuries. During interviews, facility direct care staff stated that they are trying to determine what the resident?s triggers are as the aggressive and combative behaviors are not consistent and that on any particular time of day that the resident will become physically aggressive, and refuse care. Since 04/15/2022 the resident has remained in care without documented evidence that a structured plan of care had been developed that identifies: (1)Direct care staff were provided guidance on implementing a plan of care for increased supervision of the resident to decrease the falls with injuries and that supported the residents? ability of maintaining the highest level of independence. (2)That established guidance for direct care staff to implement that would ensure that the aggressive behaviors had no further negative impact on the health, safety and well-being of the resident or others. (3)That identifies guidance from the resident?s physician that would support facility staff when the resident refused medication administration.
Plan of Correction:	FACILITY RESPONSE: "Responsible party was notified that the on-site therapy order submitted on date of admission did not accept residents? insurance. Several documented attempts were made to secure an onsite Therapy provider. Therapy services began as soon as a provider was located. Cardiac Connections was acquired and began on 5/11/20222. Staff utilize their Dementia training and skills when a resident is exhibiting aggressive and challenging behaviors. Reducing stimulation and bringing to a safe space with supervision, a staff member will sit nearby allowing resident the space to deescalate and reapproach. Offering a walk on or off the unit, music intervention, offering favorite snacks, activities, asking if she is in pain. Staff will document intervention attempted and whether successful following each behavioral outburst. 1)Resident is encouraged to participate in assisting in her care to promote independence as she is able and is monitored for safety by direct care staff in reducing falls. Documentation will be completed each shift. Care plan will reflect this need to better communicate resident individual needs to direct care staff. 2) Staff are trained to bring resident to another area in Memory Care if another residents behavior is negatively impacting other residents. Attempting to engage resident in a productive safe activity. Direct Care staff are in serviced on challenging/aggressive dementia behaviors and this will be reinforced at the Inservice on 8/25/2022. A structured plan of care has been developed for the resident to address aggressive behavior and refusal of care. 1) Direct care staff have completed required in-service on aggressive and challenging behaviors. 2) A secondary in-service reviewing interventions for the staff for aggressive behaviors will be completed by 8/25/2022. 3. A request on 8/1/2022 has been made to the physician for resident medication administration refusals to offer guidance to the staff and will be documented/followed and placed in resident chart for record. "
Standard #:	22VAC40-73-460-D
Complaint related:	Yes
Description:	Based on the review of facility records and interviews conducted with the facility Administrator and facility staff the facility failed to ensure that supervision of resident schedules, care, and activities, including attention to specialized needs, such as prevention of falls was provided. Evidence: Resident #1- Documented date of admission 04/15/2022 The facility?s Progress Notes documents that were submitted for the inspector?s review noted the following: 04/15/2022: The facility Administrator noted in part that the resident is ?a high fall risk due to weakness and dementia?. 04/24, 27/2022: Facility staff documented the multiple times the resident was observed ?getting in the floor- and ?staff replaced resident back into wheelchair?. 05/03/2022: The resident had a fall with injuries that required outside emergency medical intervention. 05/04/2022: Facility staff documented that the resident continues to get out of wheelchair and onto the floor. 05/10/2022: The resident had a fall with injuries that required outside emergency medical intervention. 06/09/2022: The resident had a fall with injuries that required outside emergency medical intervention. Facility records submitted for the inspector?s review revealed a 04/12/2022 Physician?s Admission Orders document that notes in part under the heading Primary Diagnosis ?Decreased mobility with recent GLF?. (Ground level fall) While facility staff documented the multiple times the resident got out of the wheelchair and had falls and facility records identify that resident #1 has a history of falls, the facility did not develop a documented plan of care that identified the direct care staff?s responsibility for increased supervision to minimize the resident?s falls and falls with injury.
Plan of Correction:	Resident was relocated to memory care due to dementia, behavior disturbances and increased supervision for safety. Direct care staff are documenting each shift in resident progress notes all interventions completed to prevent or reduce injury. A care plan review of all resident charts will be completed by Nurse Manager to ensure there is a documented plan of care identifying the direct care staff?s responsibility for increased supervision as needed to reduce risk of resident falls. "