VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Karolwood Gardens at Norfolk
6403 Granby Street
Norfolk, VA 23505
(757) 451-2400

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

Inspection Date: Jan. 31, 2022

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 RESIDENT CARE AND RELATED SERVICES

Comments:

An unannounced complaint inspection was initiated on 01/31/2022 and concluded on 03/03/2022. A complaint was received by the department regarding allegations in the areas of resident care and related services. The licensing inspector conducted an on-site observation at the facility on 01/31/2022 and 02/14/2022. Records were reviewed along with staff interviews held. Any violations related or not to the complaint but identified during the course of the investigation can be found on the violation notice.

Violations:

Standard #:	22VAC40-73-650-C
Complaint related:	No
Description:	Based on record review and interview, the facility failed to ensure physician?s or other prescriber?s oral orders be reviewed and signed by a physician or other prescriber within 14 days. Evidence: 1. A Physician Order/Telephone Order for Resident #1 was dated 01-08-2022 for two tablets of Ibuprofen 200 mg to be administered PRN for pain/headache by mouth every 6 hours; however, the order was not signed by a physician or other prescriber as of 01-31-2022. Upon review of medication orders for Resident #1, there was a signed order on 12/27/21 for PRN Ibuprofen 200 mg every 8 hours as needed. 2. Resident #1?s MAR states ?Ibuprofen 200 mg ? Give 2 tabs po Q 6 PRN pain/headache? with ?give liquid equivalent (25 ml) Ibuprofen? and does not indicate the PRN order of Ibuprofen 200 mg every 8 hours as needed. 3. Staff #2 was unable to provide documentation the physician changed, reviewed, and signed the oral order of Ibuprofen for Resident #1 on 1/31/22. Staff #2 was also unable to provide documentation to support the use of liquid equivalent as there was not a physician?s oral order or signed order on 1/31/22.
Plan of Correction:	A signed telephone order was completed for Resident #1. A clarification order was obtained by the physician for Resident #1. A 100% audit will be completed on all current residents' charts to ensure that oral/verbal physician orders, 1) have been reviewed by the physician 2) and that verbal/oral orders have been signed within 14 days An in-service will be completed by the Resident Care Coordinator for all RMAs and LPNs. The in-service will re-educate all LPNs and RMAs regarding the facility standard for medication pass, physician orders and process for recording and reporting medication effectiveness to physician. Resident Care Coordinator/designee will complete an audit of MARs and 3x a week for 8 weeks on the newly created Administration of PRN Medications Audit Form to ensure the facility follows the facility standard for medication pass, reordering medications, and physician orders. Additional audits may be completed as part of the quarterly healthcare oversight and findings will be reported to the administrator. Any identified variances will be investigated and corrected as appropriate.
Standard #:	22VAC40-73-680-K
Complaint related:	No
Description:	Based on record review and interview, the facility failed to ensure one or more of the conditions listed in the standard are met to permit the use of PRN medications. Evidence: 1. The MAR indicates Resident #1 received a dose of PRN Ibuprofen from Staff #3 (RMA) on 1/25/22. 2. Staff #2 acknowledged Resident #1 was administered PRN medication by an RMA and does not have a detailed medication order from the resident?s physician or other prescriber that include symptoms that indicate the use of the medication, exact dosage, the exact time frames the medication is to be given in a 24-hour period, and directions as to what to do if symptoms persist.
Plan of Correction:	A detailed PRN ordered was obtained for Resident #1. A 100% audit will be completed on all current residents' charts to ensure that PRN medication orders, 1) indicate for which symptoms to give the PRN medication, 2) an exact dose to be given, 3) an exact time-frame in which the medication may be administered within a 24-hour period, 4) and directions as to what to do should symptoms persist. An in-service will be completed by the Resident Care Coordinator for all RMAs and LPNs. The in-service will re-educate all LPNs and RMAs regarding the facility standard for medication pass, PRN orders, physician orders and process for recording and reporting medication effectiveness to physicians. Resident Care Coordinator/designee will complete an audit of resident charts 3x a week for 8 weeks (about 2 months) on the newly created PRN Medication Audit Form to ensure the facility follows the facility standard for and physician orders. Additional audits may be completed as part of the quarterly healthcare oversight and findings will be reported to the administrator. Any identified variances will be investigated and corrected as appropriate.