VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Magnolia Ridge ALF
1007 Amherst Street, SW
Roanoke, VA 24015
(540) 342-8861

Current Inspector: Cynthia Jo Ball (540) 309-2968

Inspection Date: April 19, 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 ARTICLE 1 ? SUBJECTIVITY 32.1 REPORTED BY PERSONS OTHER THAN PHYSICIANS 63.2 GENERAL PROVISIONS 63.2 PROTECTION OF ADULTS AND REPORTING 63.2 LICENSURE AND REGISTRATION PROCEDURES 63.2 FACILITIES AND PROGRAMS 22VAC40-90 BACKGROUND CHECKS FOR ASSISTED LIVING FACILITIES 22VAC40-90 THE SWORN STATEMENT OR AFFIRMATION 22VAC40-90 THE CRIMINAL HISTORY RECORD REPORT 22VAC40-80 THE LICENSE 22VAC40-80 THE LICENSING PROCESS 22VAC40-80 COMPLAINT INVESTIGATION 22VAC40-80 SANCTIONS

Comments:

Type of inspection: Renewal Date of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 04/19/2023 8:40am until 1:30pm The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. Number of residents present at the facility at the beginning of the inspection: 25 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 6 Number of staff records reviewed: 3 Number of interviews conducted with residents: 3 Number of interviews conducted with staff: 2 An exit meeting will be conducted to review the inspection findings. 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 Cynthia Ball-Beckner, Licensing Inspector at 540-309-2968 or by email at cynthia.ball@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-250-D
Description:	Based on staff record review, the facility failed to ensure that all employees completed a screening for tuberculosis annually. EVIDENCE: 1. The record for staff person 1, hired on 10/30/2006, has documentation that the last screening for tuberculosis was completed on 10/07/2021.
Plan of Correction:	The TB screening was completed by Nurse on day of inspection. Administrator will ensure that all TB screening are performed annually.
Standard #:	22VAC40-73-325-B
Description:	Based on resident record reviews, the facility failed to ensure that a fall risk rating was completed annually for resident assessed as assisted living level of care. EVIDENCE: 1. The record for resident 4 has documentation that the last fall risk rating completed for this resident was dated 01/07/2022. The uniform assessment instrument (UAI) dated 01/05/2023 in the record for resident 4 has documentation that the resident is assessed as assisted living level of care.
Plan of Correction:	Fall risk rating was completed. The administrator will ensure that all fall risk ratings will be accessed annually.
Standard #:	22VAC40-73-450-C
Description:	Based on resident record reviews, the facility failed to ensure that identified needs were addressed on individualized service plans (ISP). EVIDENCE: 1. The record for resident 6 has documentation that the resident receives mental health services. The ISP dated 11/06/2022 does not address this identified need.
Plan of Correction:	The need for mental heath services was identified on the ISP
Standard #:	22VAC40-73-660-B
Description:	Based on observations and resident record review, the facility failed to ensure that only residents whose uniform assessment instrument (UAI) indicate they are capable of self-administering medications stored medications in their rooms. EVIDENCE: 1. On the day of inspection a bottle of Advil PM and a bottle of Excedrin Migraine were observed sitting out on the top of a dresser in the room for resident 6. A review of the UAI dated 10/10/2022 in the record for resident 6 has documentation that the facility administers medications to resident 6. There was no documentation of a physician order for these medications in resident 6?s record.
Plan of Correction:	Both bottles of Advil PM and Excedrin Migraine were removed from resident?s room day of inspection. Medication policy was reviewed with the resident to notify the facility if there?s any complaints of pain or discomfort. Do not purchase over-the-counter medications.
Standard #:	22VAC40-73-870-E
Description:	Based on observation, the facility failed to ensure that all furnishings, fixtures, and equipment shall be kept clean and in good repair and condition. EVIDENCE: 1. The light fixture above the medication room was noted to be hanging loose from the ceiling on one side. 2. The light fixture above the sink in room 17 was missing and the light was inoperable after flipping on the corresponding light switch.
Plan of Correction:	1. Light fixture repaired 2. Light bulb was replaced and now in working condition
Standard #:	22VAC40-73-880-B
Description:	Based on observations of the facility physical plant, the facility failed to ensure that electric space heaters were only used in an emergency provided their installation or operation has been approved by the state or local building or fire authorities. EVIDENCE: 1. At 9:22am on the day of inspection a electric space heater was observed on and in use in room 17.
Plan of Correction:	The electric space heater was removed out of the room. Policy regarding use of space heaters for emergency use reviewed with staff by the administrator.
Standard #:	22VAC40-73-930-B
Description:	Based on observations of the physical plant and staff and resident interviews, the facility failed to ensure that a signaling device was easily accessible to residents in their rooms that terminates at a central location that is continuously staffed and permits staff to determine the origin of the signal or is audible and visible in a manner that permits staff to determine the origin of the signal. EVIDENCE: 1. During the day of inspection both LI?s were unable to locate the pendant device for the facility signaling system for room 9, 12, 14, 17, 21, and 22. A signaling device pendant located in room 31 was pushed by the LI but it alerted to the signaling box that it was room 12. Interview with residents expressed that they do not have signaling devices in their rooms. Interview with staff 3 expressed that residents frequently remove the signaling pendant devices from their rooms and then lose them.
Plan of Correction:	The new signaling system is in review and will be upgraded. Increased monitoring by staff is in place until the upgrade is completed.