VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Liza's Residential Care
5084 Langston Court
Virginia beach, VA 23464
(757) 495-9722

Current Inspector: Margaret T Pittman (757) 641-0984

Inspection Date: Nov. 20, 2019 and Nov. 21, 2019

Complaint Related: No

Areas Reviewed:

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 ACCOMODATIONS AND RELATED PROVISIONS 22VAC40-73 BUILDING AND GROUNDS 22VAC40-73 EMERGENCY PREPAREDNESS

Technical Assistance:

Please review the current standards and obtain copies of the recent updated model forms from the DSS website.

Comments:

An unannounced renewal inspection was conducted on 11-20-19(7:45 a.m until 1:50 p.m. and on 11-21-19(7:00 a.m until 7:18 a.m). There were five residents in care .Two new residents had been admitted . There were no changes staff. Two residents were observed receiving morning medications . Interviews were conducted with residents, staff, a collateral contact, and family. Four resident records and three staff records were reviewed. The lunch meal of tuna sandwiches, grapes and chips was observed. The generator installed last month covers the entire facility and is tested every Wednesday. Please complete the ?plan of correction? for each violation cited on the violation notice and return it to me within 10 calendar days from today on 12-15-19 You will need to specify how the violation will be or has been corrected. Just writing the word ?corrected? is not acceptable. Your plan of correction must include: 1. steps to correct the noncompliance 2. measures to prevent reoccurrences 3. Person(s) responsible for implementing and monitoring each step of the corrective measures and / or the preventative measures

Violations:

Standard #:	22VAC40-73-325-A
Description:	Based on record review and interview the facility failed to ensure by the time the comprehensive ISP was completed,two residents who met the criteria for assisted living care had a written fall risk rating completed. Evidence 1. While reviewing the resident records with staff #1 and #2, the inspector found the Uniform Assessment Instrument (UAI) documented at the time of admission that resident #1 admitted 12-28-19, and resident #4 admitted 8-20-18,met the criteria for assisted living care. The inspector did not observed a risk rating on file by the time the comprehensive ISP was completed. 2. Resident #1's updated UAI signed and dated by staff #2 on 5-18-19 and resident #4's UAI signed and dated by staff #2 on 5-22-19, also documented the residents met the criteria for assisted living care. 3.. As of the date of the inspection(11-20-19) no fall risk rating had been completed on resident #1 or resident #4 . 4. Staff #2 acknowledged resident #1 nor resident #4 had a completed fall risk rating on file.
Plan of Correction:	The administrator will ensure that the residents had a fall risk rating on file. The administrator will create a policy about fall prevention and provide a written form to record the risk ratings of the residents. This must be address also to the ISP
Standard #:	22VAC40-73-450-A
Description:	Based on record review, observation, and interview the facility failed to ensure on or within seven days prior to the day of admission the preliminary plan of care developed addressed the basic needs of a new resident adequately to protect the resident's health, safety, and welfare. Evidence 1. During the tour of the facility with staff #1, the inspector observed resident #2 who was admitted 11-18-19,seated in the day-room with a chair alarm attached to the chair. Resident #2 also had a catheter bag attached to his right leg. While checking the residents' sleeping areas the inspector observed a bed alarm attached to resident #2's bed. 2. The preliminary ISP signed and dated 11-10-18, did not address the catheter care services needed ,the bed and chair alarms in use , or the identified resident's need for assistance with bowel, transfers, and disorientation as noted on the 11-10-19, Uniform Assessment Instrument.The preliminary plan observed on file did not adequately protect the resident's health and safety. 3. Staff #1 stated." resident #2 was admitted with the catheter two days ago and the doctor will be called today(11-20-19) to request an order for home health to managed the catheter care". Later during the inspection staff #1 told the inspector," the doctor had been called but the doctor was out of the office for a few days".
Plan of Correction:	The administrator will ensure that within seven days prior to the day of admission of the resident , the partial plan must be developed especially the vital needs to protect the resident health, safety and welfare. Request immediately to the physician if the resident needs a skilled nursing services and therapy. All services must be properly addressed to the ISP.
Standard #:	22VAC40-73-450-C
Description:	Based on record review, observation, and interview the facility failed to ensure two of four comprehensive individualized service plans completed within 30 days after admission included the following: The description of identified needs, A written description of what services will be provided to address identified needs, and if applicable, other services, and who will provide them; When and where the services will be provided; The expected outcome; The date outcome achieved Evidence 1. During a review of the ISPs with staff #1 and #2 , the inspector observed resident #1's ISP signed and dated 5-22-19, did not include the resident's twice a week daycare attendance ,intermittent bladder incontinence that staff #1 stated occurs ,or the action to be taken if the resident has an allergic to Capaxone 2. Also resident #4's ISP dated and signed 7-12-19 ,did not include the transfer assistance identified on the UAI completed on 5-22-19, the chair cushion the inspector observed in use and staff #1 stated" was used to prevent the resident from sliding out of the chair, " or the inventions/strategies to prevent resident #4's falls. 3. Staff #2 acknowledged residents #1 and #4 ISPs' needed to be updated .
Plan of Correction:	The administrator will ensure that the ISP must be complete and comprehensive. All the outside activities of the resident must be documented. The allergy of the resident must be noted and what reaction. The miscellaneous pillows/cushion on the residents must be address to the ISP and must have an order from a physician.
Standard #:	22VAC40-73-460-E
Description:	Based on record review and interview the facility failed to document in the residents' records notable change in the residents' condition or functioning, including illness and any corresponding action taken. Evidence 1. While reviewing three closed resident files with staff # 1 and #2, ,the inspector found resident #6 was sent to the emergency room on 11-3-19 and expired in the hospital on 11-4-19 . There was no documentation of any illness or change in the resident's health on file indicating why the resident went to the emergency room. Staff #1 stated "the resident had a fever".The inspector did not observed any documentation regarding a fever in the resident's record. 2. Resident #7 who was admitted on 6-1-19. The documentation observed in the shift report indicated the resident expired in the facility on 10-31-19 between 2 a.m and 3 a.m. Resident #7's initial 5-24-19, signed and dated uniform assessment instrument observed on file, indicated the resident was totally dependent in bathing ,dressing , transferring, toileting, bowel, and bladder. The documentation the inspector reviewed indicated the resident was receiving occupational and physical therapy(PT) from 6-2019 until 8-1-19 . On 9-27-19 wound care services started and the PT services resumed.The shift report notes indicated "PT present 10-30-19". The facility had no documentation of file regarding the onset of the wound , the location of the wound or the wound care and physical therapy services provided by home health . Staff #1 stated "I think the resident had a skin tear on the leg". Resident #7's file had no documentation on file of any health changes. 3. The inspector observed documentation in the shift report that resident # 8 went to the emergency room on 7-17-19 but there was no documentation on file of any changes in the resident's health which lead to the need for emergency medical care. Resident #8, returned to the facility on hospice .Staff #1 and #2 searched the record for the date the resident return to the facility or documentation of the hospice services or the hospice contract . Staff #1 stated "it is not documented in the record ".The inspector reviewed a shift note indicating the resident expired on 8-13-19.
Plan of Correction:	The administrator will ensure to documents all changes of the resident conditions. It will create a policy , to notes every month and the latest outcome of the resident condition into the nurses/ staff note of the resident folder.
Standard #:	22VAC40-73-520-I
Description:	Based on observation and record review the facility failed to ensure the written schedule of activities met the following criteria: If one activity was substituted for another, the change was noted on the schedule. Evidence 1. While touring the facility with staff #1, the inspector observed the posted 10:00a.m. schedule activity was chair exercise. 2. The inspector observed all five of the residents in care seated in the day-room but none were engaged in any chair exercise. Resident #1 was observed sitting next to staff #4, looking at some pictures of birds. Resident #2 ,#4 and #5 were observed nodding in their chairs. In the corner of the day-room resident # 3 was observed working with her physical therapist. 3. Staff #1 acknowledged the residents were not engaged in the scheduled activity..
Plan of Correction:	The administrator will ensure that the activities calendar posted on the wall must be followed accordingly . Advice the staff to do the necessary activities as per scheduled.
Standard #:	22VAC40-73-560-I
Description:	Based on record review and interview the facility failed to have a current picture on file for one of the two new residents for identification purposes. Evidence 1. During the review of the resident records with staff #2, the inspector did not observed on file a picture of resident #3 admitted 10-27-19. 2. Staff #2 stated "a picture had not been obtained yet"
Plan of Correction:	The administrator will ensure that each residents upon admission have a current picture for proper identification.
Standard #:	22VAC40-73-610-B
Description:	Based on observation and interview the facility failed to ensure the menus for meals and snacks for the current week dated and posted in an area conspicuous to residents included substitutions or additions Evidence 1. During the tour of the facility with staff #1, the inspector observed the posted menu listed eggs and sausage for breakfast on 11-20-19, but the inspector was told by residents interviewed on that day that pancakes were served. 2. Staff # 1 told the inspector," yogurt was served for the morning snack" on 11-20-19. but crackers were listed on the menu for the morning snack. 3. The 11-20-19 menu substitutions or additions were not recorded on the posted menu.
Plan of Correction:	The administrator will ensure that the menus posted must be followed. Advice the staff if there is a changes on the menus, write the substitutes and posted on the wall board.
Standard #:	22VAC40-73-640-A
Description:	Based on record review and interview the facility failed to implement their written plan for medication management that addressed procedures for administering medication and included: Methods for verifying that medication orders have been accurately transcribed to the medication administration records (MARs) within 24 hours of receipt of a new order or change in an order. Evidence 1. While verifying resident #2's medications orders and reviewing the medication administration record with staff #2 , the inspector found the resident's Glipizide 40 mg tab 2 tablets twice daily (diabetes) was transcribe on the MAR as Glipizide 10 mg twice daily. 2. The 11-12-19 prescription on file documented Glipizide 40 mg tab 2 tablets twice daily (diabetes). The label on the medication observed in the medication cart matched the prescription. 3.The facility medication management plan indicated staff #1, would verify the orders transcribed by staff # 2. 4. Staff #2 stated "staff #1 did not verify the order was transcribed correctly. "
Plan of Correction:	The administrator will implement the medication management plan as per written on the policy. In addition the administrator and the responsible staff will checked the MAR and the medication cart every month to make sure is in proper order. This will be recorded and keep it on file.
Standard #:	22VAC40-73-680-D
Description:	Based on observation, record review, and interview the facility failed to ensure a resident's medications was administered in accordance with the physician's instructions . Evidence 1. During the medication observation with staff #1, around 7:10 a.m on 11-21-19, the inspector observed staff #1, administer resident #2's Janumet 50mg/100mg tablet (diabetes) with a cup of water. 2. The 11-18-19, signed physician order on file observed by the inspector instructed the medication be administered with meals . 3. Staff #1 stated "the resident had breakfast already".
Plan of Correction:	The administrator will ensure that the resident?s medications must be administered according to the physician?s orders. Also to follow the rights of medication administrations.
Standard #:	22VAC40-73-690-B
Description:	Based on record review and interview the facility failed to ensure for each resident assessed for assisted living care, a licensed health care professional, practicing within the scope of his/her profession,performed a review every six months of all the medications of the resident. Evidence 1. During a review of the facility records with staff #2 , the inspector found the last medication review was completed almost ten months ago on 1-29-19. 2. Staff #2 said "the 1-29-19, medication review was the last review completed by the facility's pharmacy"..
Plan of Correction:	The administrator will ensure that all the medications of the residents must have a pharmacy. Oversight every six months. Keep all notes noted on the facility files.