VIRGINIA DEPARTMENT OF SOCIAL SERVICES

The Harmony Collection at Roanoke Assisted Living
4402 Pheasant Ridge Road
Roanoke, VA 24014
(540) 970-3524

Current Inspector: Holly Copeland (540) 309-5982

Inspection Date: Feb. 7, 2023

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

Comments:

Type of inspection: Renewal Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 02/07/2023 from 09:00 AM to 05:00 PM The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. 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 #:	22VAC40-73-250-C
Description:	Based on record review, the facility failed to ensure that documentation of certain personal and social data is to be maintained on staff and shall be included in the staff records. EVIDENCE: 1. Staff 5 administers medications to residents; however, the record for staff 5 did not contain verification of current registration as medication aide. 2. The record for staff 2 lacked verification that staff 2 had received a copy of their current job description as a registered medication aide (RMA).
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-260-A
Description:	Based on staff record review, the facility failed to ensure each direct care staff member has current certification in adult first aid. EVIDENCE: The record for staff 2 contained documentation that the staff person received certification in child/infant CPR AED and adult CPR AED on 04/13/2021; however, the certification did not include certification in adult first aid. This was also noted by staff 7.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-320-A
Description:	Based on resident record review, the facility failed to ensure the physical examination and report by an independent physician for a resident within the 30 days preceding admission contained all required components. EVIDENCE: 1. Resident 3 was admitted to the facility on 01/07/2023. 2. The report of resident physical examination for the resident, dated 12/22/2022, was lacking the following information: weight, blood pressure, whether the resident is capable of self-administering medication and the results of a risk assessment documenting the absence of tuberculosis 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.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-320-B
Description:	Based on resident record review, the facility failed to ensure that a risk assessment for tuberculosis was completed annually for each resident. EVIDENCE: 1. The record for resident 4 contained documentation that the last assessment for tuberculosis was completed on 10/26/2021. 2. The record for resident 8 contained documentation that the last assessment for tuberculosis was faxed to the facility on 01/05/2022; however, the form did not contain the signature of the physician nor the date that the form was completed.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-350-B
Description:	Based on record review, the facility failed to ascertain, prior to admission, whether a potential resident is a registered sex offender if the facility anticipates the potential resident will have a length of stay greater than three days and shall document in the resident?s record that this was ascertained and the date the information was obtained. EVIDENCE: 1. The record for resident 6, date of admission 10/31/2022, contained a sex offender check which was dated 12/08/2022. 2. Interview with staff 7 revealed that there were no other sex offender checks found for this resident. 3. Resident 3 was admitted to the facility on 01/07/2023; however, the registered sex offender search in the record for resident 3 was dated 01/09/2023. 4. Staff 8 confirmed that the resident?s date of admission was 01/07/2023.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-440-D
Description:	Based on resident record review, the facility failed to ensure that private pay uniform assessment instruments (UAI) were completed as required. EVIDENCE: The UAI dated 05/02/2022 in the record for resident 4 was noted to be incomplete on the day of inspection as the area for assistance with eating/feeding was blank and did not assess what type of assistance, if any, the resident needs with eating/feeding.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-450-D
Description:	Based on record review, the facility failed to ensure that when hospice care is provided to a resident, the services provided shall be included on the individualized service plan. EVIDENCE: The ISP for resident 5, dated 10/26/2022, does not indicate that resident 5 has been receiving hospice services since 12/13/2022.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-450-E
Description:	Based on resident record review, the facility failed to ensure the individualized service plan (ISP) for a resident was signed and dated by the resident or his legal representative. EVIDENCE: The ISP for resident 2, with a subsequent review date of 12/14/2022, was not signed and dated by the resident or the resident?s legal representative.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-650-E
Description:	Based on resident record review, the facility failed to ensure that physician's or other prescriber's signed written order or a dated notation of the physician's or other prescriber's oral order were retained in resident records. EVIDENCE: 1. The February 2023 medication administration record (MAR) for resident 9 contained documentation of a physician?s order for: Diclofenac Sodium 1%- Gel Voltaren 1% Gel, apply 2 gm topically 3 times a day, in the morning, at noon and at bedtime to painful joints; however, an order for the application of this medication to be routinely administered three times a day was not in the record for resident 9 at the time of the record review. 2. Staff 8 contacted the pharmacy, and a copy of the order was faxed to the facility on the date of inspection at 3:28 PM. 3. The Diclofenac Sodium 1%- Gel Voltaren 1% Gel was also observed at resident 9?s bedside during the morning medication pass on the day of inspection. 4. Interview with resident 9 expressed that she applies the gel herself when she needs it; however, collateral 2 could not locate a physician?s order in the record for resident 9 to keep at bedside and to self-administer.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-680-C
Description:	Based on record review and observation, the facility failed to ensure that medications shall be administered not earlier than one hour before and not later than one hour after the facility?s standard dosing schedule, except those drugs that are ordered for specific times, such as before, after, or with meals. EVIDENCE: 1. On the date of inspection, LI observed staff 2 administer the following medications to resident 7 between 09:30 AM and 10:00 AM: Amlodipine Besylate 5 mg tab, Atorvastatin 20 mg tab, Duloxetine HCL Dr 60 mg cap, Atenolol 25 mg tab, Furosemide 40 mg tab, Losartan Potassium 100 mg, Vitamin B12 1000 mcg tab, Memantine HCL 5 mg tab, and Potassium CL ER 10 meq tab. Alternately, on the date of inspection, the record for resident 7 contained the most recently signed summary of physician?s orders, effective 12/2022, which indicate that those medications are ordered for 08:00 AM. 2. The record for resident 10 contained a physician?s order, dated 01/20/2023, that the following medications are to be administered to the resident at 07:00 AM daily: Pantoprazole 40 MG, Loratadine 10 MG, Culturelle, Venlafaxine 75 MG, Therems-M Tablet, Levetiracetam 1,000 MG, and Metoprolol Tartrate 25 MG. Alternately, during the on-site inspection on 02/08/2022, collateral 1 observed staff 2 administer the 07:00 AM medications to resident 10 at 09:16 AM.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-680-D
Description:	Based on resident record and medication administration record (MAR) review, the facility failed to ensure that medications were administered in accordance with physician instructions. EVIDENCE: 1. The record for resident 12 has a physician?s order dated 06/08/2022 stating ?Please check blood pressure prior to administering hypertensive medication, hold if BP is below 120/80?. 2. The January 2023 MAR has a physician order for Lisinopril 20 MG, take ? tablet (10 MG) by mouth once daily for hypertension, hold if blood pressure is less than 120/80. 3. The January 2023 MAR for resident 12 has documentation of the resident?s blood pressure being 113/72 at 08:00 AM on 01/17/2023, 108/62 at 08:00 AM on 01/19/2023 and 107/64 at 08:00 AM on 01/20/2023; however, staff initials are present for administering the prescribed Lisinopril 10 MG on these dates when resident 12?s blood pressure was outside of parameters to be administered. 4. The record for resident 12 has a physician order dated 01/31/2023 to ?Please check BP daily. If systolic is below 120 please hold medication and/or if diastolic is below 80 please hold medication (Lisinopril)?. 5. The February 2023 MAR for resident 12 has documentation of the resident?s blood pressure being 132/72 at 08:00 AM on 02/01/2023; however, staff initials are present for administering the prescribed Lisinopril 10mg on this date when resident 12?s blood pressure was outside of parameters to be administered. 6. The record for resident 3 contained a signed physician?s order, with a timestamp of 01/05/2023 09:33 AM, that Warfarin 6 MG is to be administered to the resident at 5:00 PM daily. 7. The January 2023 medication administration record (MAR) for resident 3 contains documentation that the aforementioned medication had been administered to the resident at 07:00 PM daily starting on 01/10/2023; however, during the on-site inspection, the record for resident 3 did not contain a physician?s order that Warfarin 6 MG should be administered at 7:00PM instead of 5:00 PM.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-700-1
Description:	Based on record review, the facility failed to ensure that when oxygen therapy is provided, the physician?s or other prescriber?s order shall include all required components. EVIDENCE: 1. The signed oxygen therapy physician?s orders for resident 6, dated 10/29/2022, did not specify the oxygen source nor the delivery device. 2. The updated signed oxygen therapy orders for resident 6, dated 01/10/2023, did not specify the oxygen source nor the delivery device.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-720-A
Description:	Based on resident record review, the facility failed to ensure that a written Do Not Resuscitate (DNR) order was included in an individualized service plan (ISP). EVIDENCE: 1. The record for resident 4 has documentation of a signed DNR order dated 12/08/2019. 2. The ISP dated 05/02/2022 for resident 4 states that the resident?s code status will be ?honored, code status verified and code status personalized? but the ISP does not include that resident 4 has a signed DNR order.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-860-I
Description:	Based on observations of the facility physical plant, the facility failed to ensure cleaning supplies were stored in a locked area. EVIDENCE: 1. A can of Lysol Disinfectant Spray was observed by collaterals 1 and 2 and by staff 7 to be sitting out on the desk in the hallway across from room 126. 2. A bottle of Reliable Carpet Pro X-Tractor was observed by collaterals 1 and 2 and by staff 7 to be sitting on the floor under the sink in the unlocked laundry room across from room 327.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-870-A
Description:	Based on observations of the facility physical plant, the facility failed to maintain the interior of the building in good repair. EVIDENCE: 1. The hallway outside of room 301 was noted to have a soft or spongy area in the center of the flooring. The spongy area caused the floor to be sunken in that spot. 2. This area was observed by collaterals 1 and 2 and by staff 7.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-90-40-B
Description:	Based on record review, the facility failed to ensure that the criminal history record check is obtained on or prior to the 30th day of employment for each employee. EVIDENCE: 1. Staff 6 was hired on 05/24/2022; however, the criminal history record check was not completed until 12/28/2022. 2. Staff 3 was hired on 10/04/2022; however, the results of a criminal record history were not obtained by the facility until 12/30/2022.
Plan of Correction:	Not available online. Contact Inspector for more information.