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: May 6, 2024

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 STAFFING AND SUPERVISION 22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-73 BUILDINGS AND GROUND

Comments:

Type of inspection: Complaint Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 05/06/2024 from 11:30 am to 2:47 pm. The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. Three complaints were received by VDSS Division of Licensing on 04/17/2024 and 04/24/2024 (2) regarding allegations in the area(s) of: Staffing and Supervision, Resident Care and Related Services, and Buildings and Grounds. Number of residents present at the facility at the beginning of the inspection: 48 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 4 Number of staff records reviewed: 0 Number of interviews conducted with residents: 4 Number of interviews conducted with staff: 3 An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation supported some, but not all of the allegation(s); area(s) of non-compliance with standard(s) or law were: Resident Care and Related Services and Buildings and Grounds. A violation notice was issued; any violation(s) not related to the complaint(s) but identified during the course of the investigation can also be found on the violation notice. 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 M. Tess Pittman, Licensing Inspector at (757) 641-0984 or by email at tess.pittman@dss.virginia.gov.

Violations:

Standard #:	22VAC40-73-470-C
Complaint related:	Yes
Description:	Based on record review, the facility failed to ensure that services are provided to prevent clinically avoidable complications, including worsening of an ulcer. Evidence: 1. Resident #4 admitted to the facility on 4/3/2024 with a wound noted to bottom. 2. Resident #4?s ISP does not address the resident?s wound nor when or who will provide care to wound. 3. Resident #4 was sent to ER on 4/25/24 due to diarrhea, decline, and worsening sacral wound.
Plan of Correction:	Resident admitted with wound noted on bottom 4/03/24. Home care ordered for wound care/PT and OT services. Home care company Center Well was treating appropriately. Due to a bout of diarrhea which compromised healing of the wound, the resident was sent to the hospital for more aggressive treatment and currently resides in a Skilled Nursing Facility. ISP should reflect home care provider addressing wound care. Inservice to be done on 5/20/24.
Standard #:	22VAC40-73-610-D
Complaint related:	No
Description:	Based on record review, the facility failed to ensure when a diet is prescribed for a resident by their physician or other prescriber, it be prepared and served according to the physician's or other prescriber's orders. Evidence: 1. Resident #4 admitted to the facility on 4/3/2024. The physical examination (dated 4/1/24) for Resident #4 indicates the resident has type 2 diabetes with a recommended diet of no concentrated sweets and mechanical soft - bite sized texture. Additionally, the discharge paperwork from the hospital (dated 4/3/24) indicates Resident #4 has a discharge diet of diabetic diet. 2. The Nurse?s Notes for Resident #4 indicates their POA questioned the diet of Resident #4 on 4/12/2024. Staff #1 wrote the resident?s file ?did NOT indicate diabetic diet.? 3. The facility was unable to provide evidence to indicate the admitting diet for Resident #4 was enacted or transcribed into their record.
Plan of Correction:	All residents? diets are to be reviewed upon admission and change of condition and addressed in the ISP. In-Service to be provided to staff week of 5/20/24.
Standard #:	22VAC40-73-680-C
Complaint related:	Yes
Description:	Based on documentation, 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. The MAR for Resident #1 indicates the resident was not administered their Acetaminophen 325 mg tablet on the following days: 4/6/24 (6am dose), 4/14/24 (6am dose), 4/16/24-4/18/24 (6am dose), 4/20/24 (6am dose), 4/21/24 (6am dose), and 4/24/24 (2pm dose). The MAR for Resident #1 also indicates the resident was not administered their 5am dose of Omeprazole 20 mg capsule on the following days: 4/6/24, 4/7/24, 4/9/24-4/12/24, 4/16/24-4/18/24, 4/20/24, 4/21/24, 4/23/24, 4/25/24, and 5/5/24. 2. The MAR for Resident #3 indicates the resident was not administered their 6am dose of Omeprazole 40 mg capsule on the following days: 4/16/24-4/18/24 and 4/21/24.
Plan of Correction:	According to an interview of the Med Tech who was on duty at the time the medications were administered but not entered on the MAR. She was given additional training on appropriate and immediate documentation at the time meds are administered. Additional In-Service to be done on 5/20/24.
Standard #:	22VAC40-73-680-E
Complaint related:	Yes
Description:	Based on record review, the facility failed to ensure medical procedures or treatments ordered by a physician or other prescriber be provided according to their instructions and documented. The documentation shall be maintained in the resident's record. Evidence: 1. The MAR for Resident #2 indicates the resident did not Accu-Chek for diabetic management on the following days: 4/6/24 (6am), 4/13/24-4/14/24 (6am), 4/16/24-4/18/24 (6am), 4/19/24 (9pm), and 4/20/24 (6am).
Plan of Correction:	Med Tech did not document Accu-Chek on MAR 4/6; 4/13; 4/14 4/16; 4/18 and 4/20. Med Tech In-served about documenting in the MAR and TAR at time meds and treatments are administered.
Standard #:	22VAC40-73-870-A
Complaint related:	No
Description:	Based upon observation, the facility failed to ensure that the interior and exterior of all buildings be maintained in good repair and kept clean and free of rubbish. Evidence: 1. The bathroom of Resident has a missing ceiling tile exposing piping and wires. Additionally, the adjacent ceiling tile is stained.
Plan of Correction:	Bathroom ceiling tile replaced on 5/10/24 by contractor. New maintenance director informed of securing area if repairs are being done by outside contractors to maintain resident safety.
Standard #:	22VAC40-73-930-B
Complaint related:	Yes
Description:	Based on record review, the facility failed to ensure there is a signaling device that terminates at a central location that is continuously staffed and permits staff to determine the origin of the signal or is audible and visible in a manner that permits staff to determine the origin of the signal. Evidence: 1. On 5/6/2024, floor staff confirmed that the second and third floor of the facility do not have a signaling device (a watch) that determines the origin of the signal if residents need to alert direct care staff of their need for assistance.
Plan of Correction:	In-Service for all staff scheduled for 5/20/24 regarding visibility and availability when a resident is in need and uses the call device. Management continues to monitor daily for compliance.