VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Adult Care Center of Roanoke Valley
2321 Roanoke Boulevard
Salem, VA 24153
(540) 981-2350

Current Inspector: Angela Marie Swink (276) 623-6575

Inspection Date: March 2, 2022

Complaint Related: No

Areas Reviewed:

22VAC40-61 GENERAL PROVISIONS 22VAC40-61 ADMINISTRATION 22VAC40-61 PERSONNEL 22VAC40-61 SUPERVISION 22VAC40-61 ADMISSION, RETENTION, AND DISCHARGE 22VAC40-61 PROGRAMS AND SERVICES 22VAC40-61 BUILDINGS AND GROUNDS 22VAC40-61 EMERGENCY PREPAREDNESS 22VAC40-80 THE LICENSE. 22VAC40-80 THE LICENSING PROCESS. 22VAC40-80 SANCTIONS. 63.2 General Provisions. 63.2 Protection of adults and reporting. 63.2 Licensure and Registration Procedures 63.2(19.2) Criminal Procedures. 22VAC40-90 Background Checks for Assisted Living Facilities 22VAC40-90 The Sworn Statement or Affirmation 22VAC40-90 The Criminal History Record Report

Comments:

The LI for the Adult Care Center of Roanoke Valley conducted an on-site renewal study at the facility on 03/02/2022 from 8:45an until 1:30pm and noted 25 participants to be in care. A tour of the facility physical plant was conducted and the morning meal and activities were observed. Medication management was reviewed. Participant and staff records as well as other forms of facility documentation were reviewed and interviews were conducted with participants and staff. An exit interview was conducted with staff on the date of inspection, where findings were reviewed and an opportunity was given for questions, as well as for providing any information or documentation which was not available during the inspection. Information gathered during the inspection determined non-compliances with applicable standards or law, and violations were documented on the violation notice issued to the facility.

Violations:

Standard #:	22VAC40-61-110-A
Description:	Based on a review of staff records, the facility failed to ensure that staff orientation contained all required information. EVIDENCE: 1. The orientation form in the records for staff persons 1, hired on 10/11/2021 and staff person 2, hired on 09/16/2021, were noted to be an old form dated in 2002 from previous regulations and did not contain all required information for orientation training.
Plan of Correction:	Staff orientation record updated, reviewed &signed with staff. 3/4/22
Standard #:	22VAC40-61-230-D
Description:	Based on a review of participant records, the facility failed to ensure that all identified needs were included on participant plan of cars (POC). EVIDENCE: 1. The nursing assessment dated 02/21/2022 in the record for participant 1 has documentation that the participant requires supervision with transfers, is a fall risk and is continent of bowel and bladder. The POC dated 02/16/2022 is inconsistent as is does not identify the need for supervision with transfers, does not identify any fall risk needs and has that the participant is incontinent at times and uses depends. 2. The physical exam dated 12/22/2021 in the record for participant 2 has documentation that the participant is allergic to penicillin. A nursing assessment dated 01/31/2022 has documentation that the participant requires supervision with mobility and is a fall risk. The POC dated 01/25/2022 is inconsistent as it has that the participant has no allergies and does not address the identified need for supervision with mobility or fall risks.
Plan of Correction:	1. Plan of Care on participant #1 updated with the following: supervision for ambulation & transfers due to fall risk; incontinent at times and uses Depends as protection. 3/7/22 2.Plan of Care has been corrected with notation of medication allergy & amended to need for supervision with mobility due to fall risk. 3/7/22
Standard #:	22VAC40-61-290-B
Description:	Based on observations made of the facility medication closet and review of the facility infection control policy, the facility failed to ensure that their infection prevention policies and procedures were followed. EVIDENCE: 1. The facility infection control policy has documentation that all participants glucometer bags and meters will be labeled with the participants name and that single use disposable safety lancets will be used for blood glucose monitoring assistance. 2. The glucometer in the bag for participant 4 was not labeled on the day of inspection. A multi-stick penlet device was also observed in the bag for participant 4. Interviews with staff expressed that this penlet is used on participant. 3. The glucometer in the bag for participant 5 was unlabeled on the day of inspection. 4. An unlabeled multi-stick penlet device was observed lying out on the shelf by the glucometer bags for participants 4 and 5.
Plan of Correction:	1. Facility blood glucose policy and procedures have been reviewed & updated with nurses & CMAs. 3/8/22 2. Glucometer for participant #4 has been labeled. All multi-stick penlets were removed on 3/2/22 and are no longer being used. 3/2/22 3. Glucometer for participant #5 has been labeled. 3/2/22 4. Multi-stick penlet was removed on 3/2/22 from the medication area. 3/2/22
Standard #:	22VAC40-61-410-A
Description:	Based on observations made of the facility physical plant, the facility failed to maintain the interior of the building in good repair. EVIDENCE: 1. Multiple ceiling tiles were noted to be stained in the quiet room, main lobby, barber shop and the nursing office. 2. Multiple scuff marks were observed on the walls in the large common room.
Plan of Correction:	1. Ceiling tiles replaced in Quiet room, Main Lobby, Barbershop & Nursing Office. 3/7/22 2. Walls painted in the large Common area. 3/31/22
Standard #:	22VAC40-61-410-E
Description:	Based on observations of the facility physical plant, the facility facility failed to ensure that all cleaning products were stored in a locked place when not in use. EVIDENCE: 1. The door the the facility barber shop was unlocked on the day of inspection. Pledge Dust and Allergy Cleaner and Champion Disinfectant Spray were noted to be sitting in an unlocked cabinet in the room.
Plan of Correction:	1. Staff were instructed & in-serviced on all keypad doors must be locked. Administration conducting audit for compliance. 3/4/22
Standard #:	22VAC40-61-520-A-1
Description:	Based on a review of facility documentation, the facility failed to ensure that contact with the local emergency coordinator to determine local disaster risks, community wide plans to address different disasters and emergency situations, and assistance, if any, that the local emergency management office will provide to the center in an emergency was conducted annually. EVIDENCE: 1. The last documentation of contact with the local emergency coordinator to review the facility emergency preparedness plan was dated 06/22/2020.
Plan of Correction:	1.Local emergency coordinator requested to review the facility emergency plan. 3/31/22 & Annually
Standard #:	22VAC40-61-520-C
Description:	Based on a review of facility documentation, the facility failed to ensure that a review of the emergency preparedness plan with participants, staff and volunteers occurred semi-annually. EVIDENCE: 1. The facility did not have documentation of a semi-annual review of the facility emergency preparedness plan with participants, staff and volunteers on the day of inspection.
Plan of Correction:	1. Facility emergency preparedness plan to be reviewed/documented w/participants, staff, & volunteers by 3/31/22, & semi-annually (Jan & July). 3/31/22 & Ongoing
Standard #:	22VAC40-61-560-A
Description:	Based on a review of facility policy and procedures, the facility failed to ensure that the plan for participant emergencies contained all required information. EVIDENCE: 1. The facility plan for participant emergencies did not contain procedures for making pertinent medical information and history available to the rescue squad and hospital, including a copy of the current medical administration record, advance directives, and Do Not Resuscitate Orders, procedures for notifying the participant's family, and legal representative and procedures for notifying the regional licensing office as specified in 22VAC40-61-90.
Plan of Correction:	1. Facility plan for emergencies policy & procedure was updated with all required & pertinent information. 3/22/22
Standard #:	22VAC40-61-560-C
Description:	Based on a review of facility documentation, the facility failed to ensure that a review of the plan for participant emergencies occurred semi-annually. EVIDENCE: 1. The facility did not have documentation of a semi-annual review of the facility plan for participant emergencies preparedness plan with all staff on the day of inspection.
Plan of Correction:	1. Facility review of participant emergencies to be reviewed/documented w/staff by 3/22/22, & semi-annually (Jan & July). 3/22/22 & Ongoing