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: April 14, 2022

Complaint Related: No

Areas Reviewed:

22VAC40-73 PERSONNEL 22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-73 BUILDING AND GROUNDS 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS Article 1 Subjectivity

Comments:

An unannounced, focused monitoring inspection was conducted by a Licensing Inspector (LI) on 04-12-2022 from 9:07 am to 2:26 pm. There were 37 residents in care at the time of the inspection. A tour of the facility was conducted, medication pass observed, medication cart audits completed, and 6 resident physician's orders and MAR's were reviewed. Information gathered during the inspection determined non-compliance(s) with applicable standards or law, and violations were documented on the violation notice issued to the facility. The areas of noncompliance were discussed with the Administrator throughout the inspection and during the exit interview.

Violations:

Standard #:	22VAC40-73-640-A
Description:	Based on observation, the facility failed to ensure their written plan for medication management includes methods to prevent the use of outdated medications. 1. While on-site on 4/14/22, there were expired medications found on each of the three medication carts in the facility. The following expired medications were observed on the cart on the first floor: Acetaminophen 500 mg tab (PRN) expired 1/31/22 and Atorvastatin Calcium 10mg tab (administered once daily) expired 9/2021 for Resident #7, Trazodone HCL 100 mg tab (administered once daily) expired 3/31/22 for Resident #8, Ondansetron HCL F/C 4 mg tab (PRN) expired on 12/31/21 for Resident #9, Acetaminophen 325 mg tab (PRN) expired 11/30/21 for Resident #10, nasal spray expired on 12/2021 for Resident #11, a unlabeled bottle of Allergy Relief expired on 2/2022, and a bottle of Nature Made C 500 mg soft gels expired 7/2021 for Resident #3. The following expired medications were observed on the cart on the third floor: Melatonin 4 mg tab (PRN) expired 2/26/22 for Resident #12, Clonazepam 1 mg tab (PRN) expired on 11/30/21 for Resident #13, and Glimepiride 1 mg tab (administered once daily) expired on 3/2/22 and Metoprolol Tartrate 25 mg tab (administered two times daily) expired on 3/2/22 for Resident #14. The following expired medications were observed on the cart on the safe, secure environment: Cetirizine 10 mg tab (PRN) expired on 1/5/21 for Resident #15 and Lorazepam .5 mg tab (PRN) expired on 3/31/22 for Resident #16. 2. The facility?s Medication Management Plan states ?medications stored in refrigeration are checked weekly for expiration dates;? however, it does not indicate methods to prevent the use of outdated medications.
Plan of Correction:	Acetaminophen 500 mg tab, Atorvastatin Calcium 10mg tab, (administered once daily) for Resident #7, Trazodone HCL 100 mg tab for Resident #8, Ondansetron HCL F/C 4 mg tab (PRN) for Resident #9, Acetaminophen 325 mg for Resident #10, nasal spray for Resident #11, Allergy Relief and a bottle of Nature Made C 500 mg soft gels expired for Resident #3 were removed from the 3 medication carts. A 100% audit will be completed on all current residents? medications were reviewed to ensure that all PRN medications are current and follow the facility standard. 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 reordering medications and PRN medications. LPNs/RMAs or designee will complete an audit of medication carts 3x a week for 8 weeks on the Administration of Medications and Related Provisions Audit Form to ensure the facility follows the facility standard for medication pass, reordering medications, and physician orders and monitoring of PRN medications. 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 #:	22VAC40-73-650-B
Description:	Based on record review, the facility failed to ensure physician or other prescriber orders, both written and oral, for administration of all prescription and over-the-counter medications and dietary supplements include the name of the resident, the date of the order, the name of the drug, route, dosage, strength, how often medication is to be given, and identify the diagnosis, condition, or specific indications for administering each drug. Evidence: 1. The signed physician order sheet dated 4/12/22 for Resident #3 included a scheduled daily order for Healthy Lax Powder and a scheduled daily order for Tramadol HCL 50mg tab; however, the MAR for Resident #3 indicates the medications have been discontinued. The facility was able to provide documentation of an order to change Miralax from daily to PRN dated 11/16/21; however, the current, signed physician order sheet included both scheduled and PRN administration of Healthy Lax Powder. The facility was unable to provide documentation discontinuing the scheduled daily order for Tramadol HCL 50mg tab. The facility was able to provide a script for PRN used of Tramadol HCL 50mg tab dated 5/13/21. Both the order for scheduled and PRN administration of Tramadol HCL 50mg tab were listed on current, signed physician order sheet dated 4/12/22. 2. The signed physician order sheet dated 4/12/22 for Resident #6 included an order for a Scopolamine Dis 1mg patch; however, the MAR for Resident #6 indicates the medication was discontinued 11/2021. The facility was able to provide an order to discontinue the patch dated 11/24/21; however, the current, signed physician order sheet included the administration of the patch.
Plan of Correction:	Resident #3 and Resident #6 has a signed physician order for administration of all prescription and over-the counter medications and dietary supplements. The signed physician orders include the name of the resident, the date of the order, the name of the drug, route, dosage, strength, how often medication is to be given and identify the diagnosis, condition, or specific indications for administering each drug. A 100% audit will be completed on all current residents by the Assistant Resident Coordinator to ensure that signed physician orders were completed per the standard. The Resident Care Coordinator will validate the audit once it is completed. An in-service will be completed by the Resident Care Coordinator/designee for RMA/LPN staff. The in-service will re-educate all staff regarding the facility standard on signed Physician Orders. Resident Care Coordinator/designee will complete an audit on signed Physician Orders for 3x a week for 8 weeks on the Signed Physician Order form. 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-C
Description:	Based on record review and observation, the facility failed to ensure medications be administered not earlier than one hour before and not later than one hour after the facility's standard dosing schedule, except those drugs that are ordered for specific times, such as before, after, or with meals. Evidence: 1. A medication observation was conducted with Staff #3 on 4/14/22 in the safe, secure environment. At approximately 10:00 am, approximately 5 residents in the safe, secure environment had not received their 9:00 am medications. Staff #3 completed medication administration in the safe, secure environment at 10:55 am with Resident #5.
Plan of Correction:	Staff #3 was terminated for failure to ensure medications be administered not earlier than one hour before and not later than one hour after the facility?s standard dosing schedule. A 100% audit will be completed on all current residents MARs/TARs by the Assistant Resident Coordinator to ensure that medications and treatments are administered per 1) physician orders, medications are available,2) all residents had MARS/TARS and 3) that all medications are administered per the facility standard. The Resident Coordinator will validate the audit once the audit is completed. 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 reordering medications and time frame of administering medications. LPNs/RMAs or designee will complete an audit of MARs and TARs 3x a week for 8 weeks on Administration of Medications and Related Provisions 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-I
Description:	Based on record review, the facility failed to ensure the MAR included all the required information. Evidence: 1. Resident #1?s Tamsulosin cap 0.4 mg has a diagnosis for BPH; however, the signed physician order sheet dated 4/11/22 for urinary retention. 2. Resident #2?s MAR does not include a diagnoses for the following medications: Atorvastatin tab 80mg, Bisoprol fum tab 5mg, and Losartan pot tab 50mg. The signed physician order on 4/12/22 does indicate diagnoses for these medication; however, it is not reflected on the MAR.
Plan of Correction:	Diagnosis were added to MARS/TARS for Resident #1 and Resident #2. A 100% audit will be completed on all current residents MARs/TARs by the Assistant Resident Care Coordinator to ensure that medications and treatments to ensure that MARs/TARs have diagnosis for each medication. The Resident Care Coordinator will validate the audit once completed. An in-service will be completed by the Resident Care Coordinator/designee for all RMAs and LPNs. The in-service will re-educate all LPNs and RMAs regarding the facility standard for adding diagnosis for medications on the MAR/TARS. LPNs/RMAs or designee will complete an audit of MARs and TARs 3x a week for 8 weeks on the newly created Administration of Medications and Related Provisions Audit Form to ensure the facility follows has a diagnosis for each medication. Additional audits may be completed as part of the quarterly healthcare oversight and findings will be reported administrator. Any identified variances will be investigated and corrected as appropriate.