VIRGINIA DEPARTMENT OF SOCIAL SERVICES

The Park at Oak Grove
4920 Woodmar Drive
Roanoke, VA 24018
(540) 989-9501

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

Inspection Date: April 13, 2022

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 RESIDENT CARE AND RELATED SERVICES

Comments:

Type of inspection: Complaint Date of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 04/13/2022 12:00pm until 3:30pm The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. A complaint was received by VDSS Division of Licensing on 03/04/2022 regarding allegations in the area of: Resident care and related services. Number of resident records reviewed: 1 Number of interviews conducted with residents: 1 Number of interviews conducted with staff: 1 An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation supported the allegation of non-compliance with standard(s) or law, and violations were issued. 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 Cynthia Ball-Beckner, Licensing Inspector at 540-309-2968 or by email at cynthia.ball@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-680-B
Complaint related:	Yes
Description:	Based on observations made, review of resident records and staff interviews, the facility failed to ensure that medications remained in the pharmacy issued container, with the prescription label or direction label attached, until administered to the resident. EVIDENCE: 1. During an interview with resident 1 in their room, a weekly Sunday through Saturday medication box was observed with a yellow pill numbered H126 in the boxes for Thursday, Friday and Saturday. Resident 1 expressed that facility staff prepare and bring this box to her weekly. In an interview with staff persons 1 and 2 it was expressed that this medication was resident 1?s prescribed Protonix 40mg, one tablet by mouth every day for GERD. Staff persons 1 and 2 explained that facility staff were placing the medication in a weekly medication box and giving it to resident 1 to take herself. 2. The uniform assessment instrument (UAI) dated 03/10/2022 in the record for resident 1 has documentation that the resident requires assistance from a layperson for medication administration. Physician orders signed on 10/3/2021 for resident 1 does not include an order that the resident can self administer the prescribed medication Protonix 40mg.
Plan of Correction:	1. Medication administration staff have been re-educated regarding medication administration procedures to include residents who self-administer vs residents who require medication administration from staff. 2. Letter will be sent to all Residents & families regarding policy for self-administering medications and the role that the medication administration staff have when a resident self-administers. 3. Resident #1 has since been discharged from community.