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: July 15, 2020 and July 16, 2020

Complaint Related: No

Areas Reviewed:

22VAC40-73 GENERAL PROVISIONS 22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES 22VAC40-73 PERSONNEL 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 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 COMPLAINT INVESTIGATION. 22VAC40-80 SANCTIONS.

Comments:

This inspection was conducted by licensing staff using an alternate remote protocol necessary due to a state of emergency health pandemic declared by the Governor of Virginia. A renewal inspection was initiated on 7/13/2020 and concluded on 7/16/2020. The administrator was contacted by telephone to initiate the inspection. The administrator reported that the current census was 121. The inspector emailed the administrator a list of items required to complete the inspection. The inspector reviewed five resident records, five staff records, staff schedules, fire drill records, health care oversight, health department inspection, fire department inspection, and dietitian report submitted by the facility to ensure documentation was complete. 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 #:	22VAC40-73-260-A
Description:	Based on review of staff records, the facility failed to ensure that a direct care staff person received first aid certification within the first 60 days of employment. EVIDENCE: 1. Staff 3 was hired on 9/26/2019, and there is no documentation to support that first aid certification was obtained. BLS (basic life support) certification from the American Red Cross obtained 8/13/2019, does not meet requirements for first aid training, according to the American Red Cross website (https://www.redcross.org/take-a-class/classes/basic-life-support-bl/LP-00027600.html).
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-450-F
Description:	Based on resident record review, the facility failed to update an individualized service plan (ISP) when the condition of a resident changed. EVIDENCE: 1. The facility identified resident 2, admitted on 2/21/2018, as a fall risk on the WHAT YOUR INSPECTOR NEEDS FROM YOU TODAY (R&M 1-ALF), and this is not addressed on the ISP. The NORTH ROANOKE ASSISTED LIVING FALL RISK OBSERVATION dated 4/19/2020 showed this resident has five of 10 risk factor, including a history of falls, four or more medications daily, use of assistive device(s), some transferring issues (not specified), and medical conditions that may contribute to falls. 2. The facility identified resident 3, admitted on 4/15/2014, as a fall risk on the WHAT YOUR INSPECTOR NEEDS FROM YOU TODAY (R&M 1-ALF), and this is not addressed on the ISP. The annual NORTH ROANOKE ASSISTED LIVING FALL RISK OBSERVATION dated 6/1/2020 showed this resident has three of 10 risk factor, including a history of falling, four or more medications daily, and medical conditions that may contribute to falls.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-650-A
Description:	Based on resident record review, the facility discontinued medications and treatments without valid orders from the prescriber. EVIDENCE: 1. The record for resident 5 has physician orders signed 1/8/2020 and 7/15/2020 to administer warfarin sodium 7.5mg daily. The medication administration record (MAR) for resident 5 shows the warfarin sodium 7.5 mg was originated 7/13/2020 and stopped 7/7/2020, with a notation that it was discontinued, and a separate entry shows the same drug was originated 7/13/2020 and continues The medication administration record (MAR) for resident 5 shows that warfarin sodium 7.5 mg was not given between 7/7/2020 and 7/13/2020. There is no physician order to discontinue this. 2. The physician orders for warfarin sodium for resident 3 do not match what is documented as being administered on the July 2020 MAR. The physician orders dated 5/13/2020 show that resident 3 is to have two 5mg tablets (total of 10mg) on Friday, Saturday, Sunday, Tuesday, Wednesday, and Thursday; the MAR shows this was discontinued on 6/30/2020 but there is no signed order to discontinue it. The physician orders also show one 7.5 mg tablet is to be administered once daily on Mondays. The MAR shows this was discontinued on 7/7/2020, and there are no signed orders for this. The MAR shows one 7.5 mg tablet of warfarin sodium is to be administered once daily on Monday beginning 6/30/2020 and stopping 7/7/2020, and there are no signed orders for this.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-680-D
Description:	Based on resident record review, the facility failed to ensure that medications were administered in accordance with the physician's or other prescriber's instructions. EVIDENCE: 1. The MAR for July 2020 for resident 5 has documentation to show that on 7/4/2020 gabapentin 300 mg was not administered, and Humulin (insulin) ws not administered. The reason states, "MEDICATION NOT GIVEN" with no actual reason it was not given. 2. The MAR for July 2020 for resident 5 has documentation to show that on 7/10/2020 Humulin (insulin) was not administered. The reason states, "MEDICATION NOT GIVEN" with no actual reason it was not given.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-680-E
Description:	Based on resident record review, the facility failed to ensure that medical procedures or treatments ordered by a physician or other prescriber were provided according to instructions and documented. EVIDENCE: 1. The MAR for July 2020 for resident 5 has documentation to show that on 7/10/2020 an accucheck was not done, and there is no documentation to show why this was not done. 2. Resident 5 has a signed physician order dated 1/8/2020 for Lubrisilk Lotion to be applied topically twice daily as needed for dry skin. There is no documentation to support that this treatment was available to the resident. It does not appear on the July 2020 medication administration record (MAR) that has been in use since 7/1/2020. It was removed from the most recent physician orders signed 7/15/2020.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-680-I
Description:	Based on resident record review, the facility failed to ensure that complete documentation was done on medication administration records (MAR). EVIDENCE: 1. The MAR for July 2020 for resident 2 lacks documentation to support that Phenytoin Sod EXT 100mg was administered at 8PM on 7/6/2020.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-680-K
Description:	Based on resident record review, the facility failed to obtain a prescription for a PRN (as needed) medication that included symptoms that indicate the use of the medication, and directions as to what to do if symptoms persist. EVIDENCE: 1. Resident 4 has order for Cogentin (benztropine mesylate) 0.5 mg 1 tablet PO, BID, PRN, Dx: Schizophrenia (One tablet by mouth, twice a day, as needed). The order does not include symptoms that indicate the use of the medication or directions as to what to do if symptoms persist. The 12/19/2019 uniform assessment instrument (UAI) shows resident 4 needs assistance in taking medications.
Plan of Correction:	Not available online. Contact Inspector for more information.