VIRGINIA DEPARTMENT OF SOCIAL SERVICES

North Roanoke Assisted Living
6910 Williamson Road
Roanoke, VA 24019
(540) 265-2173

Current Inspector: Holly Copeland (540) 309-5982

Inspection Date: April 25, 2019

Complaint Related: No

Areas Reviewed:

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

Comments:

THe LI for North Roanoke Assisted Living conducted an unannounced monitoring visit at the facility on 4/25/19 from 8:40am until 5:30pm in conjunction with another LI and under the supervision of the LA. A tour of the facility physical plant was conducted and resident records as well as other forms of facility documentation were reviewed. The facility medication management was reviewed and medication carts were audited. Interviews were conducted with residents and staff. Previous violations were reviewed. Please respond back to your LI with a plan of correction within 10 days of receipt of this notice. If you have any questions please feel free to contact your LI at 540-309-2968.

Violations:

Standard #:	22VAC40-73-440-A
Description:	Based on residents? record review and staff interview, the facility failed to ensure that uniform assessment instruments (UAIs) were completed at least annually, and whenever there is a significant change in the resident's condition. Evidence: 1. Resident 9?s individualized service plan (ISP) dated 10/4/18 denotes explosive aggressive behavior but the public pay UAI dated 12/6/18 assessed the residents behavior pattern as appropriate. Staff person 6 confirmed the UAI is not accurate but the ISP reflects resident 9?s behavior pattern as witnessed by the facility. Staff person 2 confirmed being told about previous disruptive actions from resident 9. Staff person 6 confirmed there is no written communication of the facility notifying the public assessor to reassess the resident due to a change in the resident?s behavior. 2. Resident 11 is assessed as disoriented on the public pay UAI dated 4/16/18. Staff person 6 confirmed that this is incorrect and that resident 11 is not disoriented. Staff person 6 confirmed there is no written communication of the facility notifying the public assessor to reassess the resident due to a change in the resident?s condition. 3. The ISP dated 5/1/18 in the record for resident 1 has that the resident requires mechanical assistance with dressing, toileting and transferring. The public pay UAI dated 3/25/19 has resident 1 assessed as no help is needed with these ADL's. Satff person 1 confirmed that resident 1 does need mechanical assistance with dressing, toileting and bathing. There is no written communication of the facility notifying the public assessor to reassess the resident due to a change in the resident?s condition. 4. The public pay UAI in the record for resident 12 has documentation that the last annual assessment was completed on 1/3/18. There is no written communication of the facility notifying the public assessor that an annual reassessment was due in January 2019. 5. The public pay UAI in the record for resident 15 has documentation that the last annual assessment was completed on 12/19/17. There is no written communication of the facility notifying the public assessor that an annual reassessment was due in December 2018.
Plan of Correction:	The provider?s responses for the ?plan of correction? was not received as of 5/25/2019 and will not appear on this Violation Notice.
Standard #:	22VAC40-73-450-C
Description:	Based on resident record review, the facility failed to ensure that identified needs were addressed on individualized service plans (ISPs). Evidence: 1. Resident 8?s UAI dated 2/12/19 assessed the resident as needing mechanical help only with stair climbing and disorientation to some spheres some of the time. The comprehensive ISP dated 1/15/19 for resident 8 did not address the residents disorientation or the assessed need for mechanical assistance with stair climbing. 2. The record for resident 12 has documentation of the resident receiving home health services for wound care to both of the residents lower extremities since 1/17/19. The comprehensive ISP dated 6/2/18 in the record for resident 12 does not address this identified need. 3. The record for resident 15 has documentation that the resident is a registered sex offender. The comprehensive ISP dated 1/22/19 has documentation that the Virginia State Police will monitor the residents sex offender status but it does identify any measures put in place for the facility to monitor for and inappropriate sexual behaviors.
Plan of Correction:	The provider?s responses for the ?plan of correction? was not received as of 5/25/2019 and will not appear on this Violation Notice.
Standard #:	22VAC40-73-450-F
Description:	Based on review of resident record, the facility failed to ensure that an individualized service plan (ISP) was reviewed and updated as required. EVIDENCE: 1. The ISP for resident 6, dated 2/20/2018, had not been reviewed or updated within the past 12 months.
Plan of Correction:	The provider?s responses for the ?plan of correction? was not received as of 5/25/2019 and will not appear on this Violation Notice.
Standard #:	22VAC40-73-560-E
Description:	Based on resident record reviews, the facility failed to keep resident records current. EVIDENCE: 1. The record for resident 12 has a physician order dated 1/17/19 for home health services for wound care. The record does not have any documentation of progress notes or services that have been provided by the home health agency for resident 12's wound care needs.
Plan of Correction:	The provider?s responses for the ?plan of correction? was not received as of 5/25/2019 and will not appear on this Violation Notice.
Standard #:	22VAC40-73-640-A
Description:	Based on observations, the facility failed to implement a plan for medication management. EVIDENCE: 1. The facility Controlled Drugs-Count Record forms for unit 2 were missing initials to indicate acknowledgement that the count was completed by all responsible persons at 3pm and 11pm on 4/14.2019, 3pm and 11pm on 4/23/2019; and 11pm on 4/24/2019, and 7am on 4/25/2019. 2. The facility Controlled Drugs-Count Record forms for unit 3 were missing initials at 11pm to indicate acknowledgement that the count was completed by all responsible persons for the entire month of March 2019. For the month of April 2019, as of 4/25/19, only two days had signatures for the 11pm shift change.
Plan of Correction:	The provider?s responses for the ?plan of correction? was not received as of 5/25/2019 and will not appear on this Violation Notice.
Standard #:	22VAC40-73-650-A
Description:	Based on resident record review, the facility failed to ensure that medications were not started, changed or discontinued by the facility without a valid physician order. EVIDENCE: 1. The April 2019 MAR for resident 6 shows that Acetaminophen and Tramadol were held per doctors? orders on 4/9 and 4/10/2019; however, there were no orders to hold either of these medications. The resident record included a Standing Order for Colonoscopy Prep to be started on 4/9/2019; however, neither of these medications were included on the list of medications to hold. 2. The April 2019 MAR for resident 8 indicated that the prescribed medication pravastatin sodium was discontinued on 4/4/19. The LI was unable to locate the discontinue order. Staff persons 2 and 5 were unable to produce the physician order to discontinue this medication during this inspection.
Plan of Correction:	The provider?s responses for the ?plan of correction? was not received as of 5/25/2019 and will not appear on this Violation Notice.
Standard #:	22VAC40-73-650-B
Description:	Based on review of resident record, the facility failed to ensure that physician?s orders included all required components per standard. EVIDENCE: 1. The most recent signed physician orders for resident 6, progress note dated 4/24/19, do not include the route, dosage, strength, how often medication is to be given, or the diagnosis, condition, or specific indications for administering each drug.
Plan of Correction:	The provider?s responses for the ?plan of correction? was not received as of 5/25/2019 and will not appear on this Violation Notice.
Standard #:	22VAC40-73-650-E
Description:	Based on resident record review and staff interview, the facility failed to ensure residents? record contained the physician's or other prescriber's signed written order or a dated notation of the physician's or other prescriber's oral order. EVIDENCE: 1. Resident 9 had Nitroglycern 4 mg tab PRN and Diabetic Siltussin in the medication cart in Building 3. The current sigend physician?s order sheet dated 4/17/19 nor the previous physician?s order sheet dated November 2018 had either of these medications listed. Staff persons 2 and 5 confirmed the facility does not have a physician?s order for the aforementioned medications. 2. Resident 10 had hydralazine Hcl in the medication cart in Building 3. There was no physician?s order for the medication. Staff persons 2 and 5 confirmed the facility does not have a physician?s order for the medication.
Plan of Correction:	The provider?s responses for the ?plan of correction? was not received as of 5/25/2019 and will not appear on this Violation Notice.
Standard #:	22VAC40-73-660-A-6
Description:	Based on observations, the facility failed to ensure that required medications were refrigerated. EVIDENCE: 1. The LI observed that the medication refrigerator located on unit 4 was not properly cooling on the day of inspection. The facility thermometer located inside the refrigerator was noted to be reading 60'F. Unopened insulin with manufacturer recommendations to refrigerate for numerous residents including residents 1,15 and 16 were stored in the refrigerator at the time of this observation. Facility staff determined that the refrigerator had been unplugged.
Plan of Correction:	The provider?s responses for the ?plan of correction? was not received as of 5/25/2019 and will not appear on this Violation Notice.
Standard #:	22VAC40-73-680-B
Description:	Based on medication cart audit, the facility failed to maintain medications in in the pharmacy issued container, with the prescription label or direction label attached, until administered to the resident. Evidence: 1. Resident 9 is prescribed Hydroxyzine Pamote 25 mg. The medication was observed by the LI in the presence of staff persons 2 and 5 to be in a damaged bubble package. The package was opened and exposed on the side. The capsules were stuck in disarray inside the packaging and not in their individual slots.
Plan of Correction:	The provider?s responses for the ?plan of correction? was not received as of 5/25/2019 and will not appear on this Violation Notice.
Standard #:	22VAC40-73-680-D
Description:	Based on resident record reviews, the facility failed to ensure that medications were administered in accordance with physician instructions. EVIDENCE: 1. The April 2017 MAR for resident 6 includes a physician?s order to give Potassium CL ER twice daily for 2 days beginning 4/17/2019. This MAR shows the resident was hospitalized 4/17-4/19/2019 and this medication was given at 8pm on 4/19/2019 and twice daily (8am and 8pm) since. This same MAR shows an physician?s order to start Potassium CL ER once daily at bedtime beginning 4/19/2019. The MAR shows this medication was started on 4/20 and is being given at 8am instead of bedtime as ordered. 2. The March 2019 MAR for resident 5 shows a physician?s order to hold Propranolol HCL if heart rate is less than 60 BPM. This medication was administered at 8am on 3/13/2019 with a documented heart rate of 53 and held on 3/23/2019 with a documented heart rate of 78. 3. The March 2019 MAR for resident4 shows a physician?s order to hold Metoprolol Tartrate if heart rate is less than 60. This MAR shows the medication was not given at 9:00am on 4/24/2019 with a documented heart rate of 64. 4. The April 2019 MAR for resident 1 has the medication Brilinta 60mg, 1 tablet by mouth twice a day with staff initials present twice a day from 4/9/19 through 4/25/19. The medication was noted to be in the medication cart. The most recent signed physician orders dated 4/2/19 does not have this medication listed as being prescribed by the residents physician. 5. The record for resident 16 has a signed physician order dated 4/3/19 for Olanzapine ODT 5mg disintegrating tablet daily in the morning. The LI noted that the medication was not available on the medication cart for administration but staff initials were present for administering this medication on the MAR from 4/1/19 through 4/25/19. Staff person 1 placed a call to the pharmacy in which it was expressed that the medication had been discontinued on 3/27/19 and the pharmacy was not aware of the most recent signed physician order dated 4/3/19. Pharmacy also expressed that the medication was not delivered to the facility. 6. The April 2019 MAR for resident 15 has a physician order for Montelukast Sodium 10mg, 1 tablet daily. The LI observed that 2 pills are packaged inside of each bubble on the medication card. Staff person 1 expressed that they had not noticed the 2 pills during medication administration to this resident on the day of inspection. The LI looked up the pill number (U-220) and noted that each pill is Montelukast Sodium 10mg which would equal 20mg being administered.
Plan of Correction:	The provider?s responses for the ?plan of correction? was not received as of 5/25/2019 and will not appear on this Violation Notice.
Standard #:	22VAC40-73-680-E
Description:	Based on resident record reviews, the facility failed to ensure that all required information was documented for physician ordered medical procedures or treatments. EVIDENCE: 1. The April 2019 MAR's lack documentation of the monthly vitals, scheduled for April 1, as ordered per physician?s for residents 5 and 7. 2. The April 2019 MAR for resident 17 does not have documentation of the results of the residents blood pressure check at 7pm on 4/16/19. 3. The March 2019 MAR for resident 18 does not have the results of the residents blood sugar chack at 4:30pm on 3/19/19.
Plan of Correction:	The provider?s responses for the ?plan of correction? was not received as of 5/25/2019 and will not appear on this Violation Notice.
Standard #:	22VAC40-73-680-I
Description:	Based on resident record reviews, the facility failed to ensure that all required information was documented on medication administration records (MARs). EVIDENCE: 1. The April 2019 medication administration record (MAR) for resident 6 show PRN medications were administered on4/12, 4/15, 4/23 and 4/24/2019; however the MARs lacked documentation of the effectiveness of these medications. 2. The April 2019 MAR for resident 7 has no documentation for the 8pm dose of Metoprolol Tartrate on 4/9; and the 8pm doses of Simvastatin and Terazosin HCL on 4/3, 4/4, 4/7, and 4/9. 3. The March 2019 electronic MAR for resident 6, which was printed on March 31, 2019, show handwritten initials for the administration of medications scheduled to be given on 3/8/2019. 4. The March 2019 electronic MAR for resident 7, which was printed on March 31, 2019, show handwritten initials for the administration of medications scheduled to be given on 3/8, 3/19, 3/21, 3/30 and 3/31/2019. 5. The March 2019 electronic MARs for residents 4 and 5, which were printed on March 31, 2019, shows handwritten initials for the administration of medications scheduled to be given on 3/8/2019. 6. The March 2019 electronic MAR for resident 4 shows a physician?s order to hold Metoprolol Tartrate if the resident?s heart rate is below 60. The MAR, printed on 3/31/2019, shows initials indicating Metoprolol Tartrate was administered on 3/1 and 3/4/2019 with no electronic documentation of the pulse at that time. Since being printed on 3/31/2019, these initials were circled and a handwritten pulse of 58 was documented on 3/1 and a handwritten pulse of 56 was documented on 3/4/2019. 7. Staff initials are present on the April 2019 MAR for resident 16 for administering Omeprazole DR 20mg daily from 4/1/19 through 4/25/19. This medication was discontinued on 3/27/19 and was not available in the cart.
Plan of Correction:	The provider?s responses for the ?plan of correction? was not received as of 5/25/2019 and will not appear on this Violation Notice.
Standard #:	22VAC40-73-680-K
Description:	Based on resident record reviews, the facility failed to ensure that all orders for PRN medications included symptoms that indicate the use of the medication, when medication aides administer medications in the facility. EVIDENCE: 1. The April 2019 medication administration record (MAR) for resident 1 has a physician for Narcan 4mg/0.1ml nasal spray to be administered in either nostril, may repeat in 3 minutes alternating nostrils for respiratory depression until EMT. The order does not include specific symptoms that would indicate when a medication aide would administer the medication.
Plan of Correction:	The provider?s responses for the ?plan of correction? was not received as of 5/25/2019 and will not appear on this Violation Notice.
Standard #:	22VAC40-73-860-D
Description:	Based on observation, the facility failed to ensure that operable windows were effectively screened. EVIDENCE: 1. The LIs noted an unscreened, open window in the dining area.
Plan of Correction:	The provider?s responses for the ?plan of correction? was not received as of 5/25/2019 and will not appear on this Violation Notice.