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: Sept. 20, 2023

Complaint Related: No

Areas Reviewed:

22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES 22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-73 BUILDINGS AND GROUND 22VAC40-73 EMERGENCY PREPAREDNESS

Comments:

Type of inspection: Monitoring Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 09/20/2023 from 09:00 AM until 12:45 PM The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. 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 Holly Copeland, Licensing Inspector at 540-309-5982 or by email at holly.copeland@dss.virginia.gov

Violations:

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 (ISP). EVIDENCE: 1. The record for resident 4 contains documentation under ?Diet? on the history and physical (H&P) form, dated 09/08/2022, for small portions and to avoid dry crumbly food. Licensing Inspectors did not locate any other dietary orders or recommendations in the record on the date of inspection. 2. The most current ISP in the record for resident 4 on the date of inspection, dated 07/05/2023, did not address these identified dietary needs. 3. This was also cited at the 01/05/2023 inspection as the most current ISP at that time, dated 10/05/2022, did not address those same dietary needs that were identified on the same H&P form.
Plan of Correction:	North Roanoke Assisted Living will comply with Standard 450-C. North Roanoke Assisted Living will continue to abide with standard as it relates to the facility ensuring that identified needs are addressed on the individualized service plan. The History and Physical completed for the indicated resident also had an attached diet order from the facility. The diet order was developed by the facility?s dietician and implemented in 2016. The facility currently has one diet which is referred to as House Diet. The House Diet is a low cholesterol heart healthy diet with no added sodium. This diet provides a consistent and controlled number of grams of carbohydrate for each meal and snack that is equal to 55-70 grams carbohydrate per meal and 15 to 20 grams per snack. This controlled carbohydrate content meets the needs of diabetic residents. The house diet provides 1900 to 2100 calories per day with snack. During the inspection the resident spoke with the inspectors on hand regarding this matter and stated that he had no issues with the food here and eats seconds for breakfast and dinner. Three inspectors listened to the resident as he shared his position regarding the matter and states he has no issues eating the food that is prepared at the facility. The facility?s administration requested technical assistance and received none. The facility?s administration asked for a clear definition of technical assistance and was provided with the general explanation that the inspectors are to use it at their own discretion. The facility doesn?t believe that the history and physical supersedes the facility?s diet Order which was signed by the same physician on the exact same day as the History and Physical. Furthermore, please take note that the current Auxiliary Grant (AG) rate is $1682 as of 10/5/23 and has increased over the years in small increments. In 2011 the AG was $1109 and today is $1682. The AG rate has only increased by $573, which isn?t sufficient, especially with inflation continuing. This plan of correction is submitted as required under State and Federal law. The submission of this Plan of Correction does not constitute an admission on the part of North Roanoke Assisted Living as to the accuracy of the surveyor?s findings or the conclusions drawn therefrom. Submission of this Plan of Correction also does not constitute an admission that the findings constitute a deficiency or that the scope and severity regarding the deficiency cited are correctly applied. Any changes to the North Roanoke Assisted Living?s policies and procedures should be considered subsequent remedial measures as that concept is employed in Rule 407 of the Federal Rules of Evidence and any corresponding state rules of civil procedure and should be inadmissible in any proceeding on that basis. North Roanoke Assisted Living submits this plan of correction with the intention that it be inadmissible by any third party in any civil or criminal action against North Roanoke Assisted Living or any employee, agent, officer, director, attorney, or shareholder of North Roanoke Assisted Living.
Standard #:	22VAC40-73-640-A
Description:	Based on observation during medication cart audits, the facility failed to implement a portion of its medication management plan specifically regarding counts of controlled substances. EVIDENCE: 1. The facility?s medication management plan states the following regarding ensuring an accurate count of all controlled substances: ?our medication narcotic count will be done and signed at shift change or at time they are counted. Unit managers and Director of Nursing Compliance will monitor signatures with oversite of review done by Nurse Consultant.?. 2. The Controlled Drugs-Count Record for medication cart 2B located on unit 2 did not contain signatures of the on-coming and off-going medication staff who worked from 7:00AM through 11:00PM on 09/09/2023 and the off-going medication staff who worked from 3:00PM through 11:00PM on 09/15/2023. 3. The Controlled Drugs-Count Record for medication carts 4A and 4C located on unit 4 did not contain signatures of the on-coming and off-going medication staff who worked from 7:00AM through 11:00PM on 09/15/2023. 4. The Controlled Drugs-Count Record for medication cart 4D located on unit 4 did not contain signatures of the on-coming and off-going staff who worked from 3:00PM ? 11:00PM on 09/15/2023. 5. This violation was previously cited at the 01/05/2023 inspection.
Plan of Correction:	North Roanoke Assisted Living will comply with Standard 640-A. North Roanoke Assisted Living will continue to abide with standard as it relates. The facility will submit a revised copy of their medication management plan that is suitable for their facility for approval. The facility will comply with the standards of practice outlines in the current medication aide curriculum approved by the Virginia Board of Nursing. Please take note that the current Auxiliary Grant (AG) rate is $1682 as of 10/5/23 and has increased over the years in small increments. In 2011 the AG was $1109 and today is $1682. The AG rate has only increased by $573, which isn?t sufficient, especially with inflation continuing minimum wage increases and the cost of living. This plan of correction is submitted as required under State and Federal law. The submission of this Plan of Correction does not constitute an admission on the part of North Roanoke Assisted Living as to the accuracy of the surveyor?s findings or the conclusions drawn therefrom. Submission of this Plan of Correction also does not constitute an admission that the findings constitute a deficiency or that the scope and severity regarding the deficiency cited are correctly applied. Any changes to the North Roanoke Assisted Living?s policies and procedures should be considered subsequent remedial measures as that concept is employed in Rule 407 of the Federal Rules of Evidence and any corresponding state rules of civil procedure and should be inadmissible in any proceeding on that basis. North Roanoke Assisted Living submits this plan of correction with the intention that it be inadmissible by any third party in any civil or criminal action against North Roanoke Assisted Living or any employee, agent, officer, director, attorney, or shareholder of North Roanoke Assisted Living.
Standard #:	22VAC40-73-680-D
Description:	Based on resident record review, the facility failed to ensure medications were administered in accordance with the physician?s or other prescriber?s instructions. EVIDENCE: 1. The record for resident 1 contains a physician?s order for sliding scale insulin, dated 11/03/2022, for LANTUS SOLOSTAR 100U/mL, inject 20 units subcutaneously every morning (hold if blood sugar is less than 150) and to inject 89 units subcutaneously at bedtime for diabetes type 2. 2. The August 2023 and September 2023 medication administration records (MARs) for resident 1 indicate that the resident is scheduled to receive the prescribed LANTUS at 8:00AM and 8:00PM every day. 3. The August 2023 ACCUCHECK results for this resident indicate that blood sugar readings at 7:30AM were less than 150 on 08/09, 08/14, 08/25, 08/29, and 08/30; however, the Aug. MAR also indicates that LANTUS was given in the ABD (abdomen) on those same dates at 8:00AM. 4. This violation was previously cited at the 01/05/2023 inspection.
Plan of Correction:	North Roanoke Assisted Living will comply with Standard 680-D. North Roanoke Assisted Living will continue to abide with standard as it relates to ensuring the medications are administered in accordance with the physician?s or other prescriber?s instructions. NRAL has reviewed the facility?s E-MAR Policy with registered medication aides and nurses as it relates to the medication exceptions to ensure that the appropriate documentation with an explanation is provided. The facility will comply with the standards of practice outlines in the current medication aide curriculum approved by the Virginia Board of Nursing. Please take note that the current Auxiliary Grant (AG) rate is $1682 as of 10/5/23 and has increased over the years in small increments. In 2011 the AG was $1109 and today is $1682. The AG rate has only increased by $573, which isn?t sufficient, especially with inflation continuing, minimum wage increases and the cost of living. This plan of correction is submitted as required under State and Federal law. The submission of this Plan of Correction does not constitute an admission on the part of North Roanoke Assisted Living as to the accuracy of the surveyor?s findings or the conclusions drawn therefrom. Submission of this Plan of Correction also does not constitute an admission that the findings constitute a deficiency or that the scope and severity regarding the deficiency cited are correctly applied. Any changes to the North Roanoke Assisted Living?s policies and procedures should be considered subsequent remedial measures as that concept is employed in Rule 407 of the Federal Rules of Evidence and any corresponding state rules of civil procedure and should be inadmissible in any proceeding on that basis. North Roanoke Assisted Living submits this plan of correction with the intention that it be inadmissible by any third party in any civil or criminal action against North Roanoke Assisted Living or any employee, agent, officer, director, attorney, or shareholder of North Roanoke Assisted Living.
Standard #:	22VAC40-73-870-A
Description:	Based on observation, the facility failed to ensure that the interior and exterior of all buildings shall be maintained in good repair and kept clean and free of rubbish. EVIDENCE: 1. In room 182, the central air unit mounted to the wall under the window was noted to still be missing at least one knob to operate the unit. This violation was previously cited at the inspection on 01/05/2023. 2. The flooring on the ramps between units 2, 3, and 4 had numerous areas that were broken or chipped. 3. Light-colored ceiling stains were observed in the hallway by rooms 280 and 286. This violation was previously cited at the 01/05/2023 inspection. 4. Between rooms 281 and 286, LIs observed a small brown puddle of water on the floor and water drops coming from the pipe above the puddle.
Plan of Correction:	North Roanoke Assisted Living will comply with Standard 870-A. North Roanoke Assisted Living will continue to abide by the standard it relates to the facility ensuring that the interior and exterior of all buildings shall be maintained in good repair and kept clean and free of rubbish. Please note that this is an ongoing process and there will be continuous efforts to address and maintain the interior and exterior of all buildings. 1) The PTAC unit in 182 missing knobs were reported to the maintenance personnel the same day of inspection and replaced. However, the facility has replaced numerous knobs on PTAC units and installed several new PTAC throughout the facility. The facility has advised residents to not take the knobs off of the PTAC units but due to the current population of residents that have mental health diagnosis they continue to remove them. 2) The flooring indicated is on Unit 3, is an unoccupied unit with no residents allowed to reside in this part of the facility from February 2020. This unit is 3 allows the residents to travel through the facility when inclement weather. 3) The ceiling tiles are monitored and painted when determined to be savable and replaced when needed after the condensation from the pipes in the ceiling. 4) The pipe cited is a part of the sprinkler system. The facility had an inspection of the sprinkler system in July 2023 and there were no issues to report and Fire Marshal inspection in August 2023. The indicated puddle is also from condensation from the overhead pipe and cleaned as needed. Please take note that the current Auxiliary Grant (AG) rate is $1682 as of 10/5/23 and has increased over the years in small increments. In 2011 the AG was $1109 and today is $1682. The AG rate has only increased by $573, which isn?t sufficient, especially with inflation continuing. This plan of correction is submitted as required under State and Federal law. The submission of this Plan of Correction does not constitute an admission on the part of North Roanoke Assisted Living as to the accuracy of the surveyor?s findings or the conclusions drawn therefrom. Submission of this Plan of Correction also does not constitute an admission that the findings constitute a deficiency or that the scope and severity regarding the deficiency cited are correctly applied. Any changes to the North Roanoke Assisted Living?s policies and procedures should be considered subsequent remedial measures as that concept is employed in Rule 407 of the Federal Rules of Evidence and any corresponding state rules of civil procedure and should be inadmissible in any proceeding on that basis. North Roanoke Assisted Living submits this plan of correction with the intention that it be inadmissible by any third party in any civil or criminal action against North Roanoke Assisted Living or any employee, agent, officer, director, attorney, or shareholder of North Roanoke Assisted Living.
Standard #:	22VAC40-73-870-E
Description:	Based on observation, the facility failed to ensure that all furnishings, fixtures, and equipment, including furniture, window coverings, sinks, toilets, bathtubs, and showers, shall be kept clean and in good repair and condition, except that the furnishings and equipment owned by a resident shall be, at a minimum, in safe condition and not soiled in a manner that presents a health hazard. EVIDENCE: 1. In the bathroom of room 208, the toilet seat had a large brown stain. In addition, the toilet bowl had a brown substance inside and on the outside of the bowl as well as on the wall next to and behind the toilet. 2. This violation was previously cited at the 01/05/2023 inspection.
Plan of Correction:	North Roanoke Assisted Living will comply with Standard 870-E. North Roanoke Assisted Living will continue to abide with standard as it relates to all furnishings, fixtures, and equipment should be in good repair and condition. North Roanoke Assisted Living will continue to act in accordance with the standard as it relates to the interior and exterior of all buildings being maintained in good repair and kept clean and free of rubbish. Please note that this is an ongoing process and continuous efforts to take care of the interior and exterior of all buildings are maintained. Please take note that the current Auxiliary Grant (AG) rate is $1682 as of 10/5/23 and has increased over the years in small increments. In 2011 the AG was $1109 and today is $1682. The AG rate has only increased by $573, which isn?t sufficient, especially with inflation continuing. This plan of correction is submitted as required under State and Federal law. The submission of this Plan of Correction does not constitute an admission on the part of North Roanoke Assisted Living as to the accuracy of the surveyor?s findings or the conclusions drawn therefrom. Submission of this Plan of Correction also does not constitute an admission that the findings constitute a deficiency or that the scope and severity regarding the deficiency cited are correctly applied. Any changes to the North Roanoke Assisted Living?s policies and procedures should be considered subsequent remedial measures as that concept is employed in Rule 407 of the Federal Rules of Evidence and any corresponding state rules of civil procedure and should be inadmissible in any proceeding on that basis. North Roanoke Assisted Living submits this plan of correction with the intention that it be inadmissible by any third party in any civil or criminal action against North Roanoke Assisted Living or any employee, agent, officer, director, attorney, or shareholder of North Roanoke Assisted Living.