VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Memory Care at Bristol
301 Village Circle
Bristol, VA 24201
(276) 477-5334

Current Inspector: Rebecca Berry (276) 608-3514

Inspection Date: May 2, 2023 and May 18, 2023

Complaint Related: No

Areas Reviewed:

22VAC40-73 PERSONNEL 22VAC40-73 RESIDENT CARE AND RELATED SERVICES

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: 05/02/2023, 12:04pm to 1:04pm and 05/18/2023, 1:48pm to 1:58pm The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. A self-reported incident was received by VDSS Division of Licensing on 04/06/2023 regarding allegations in the area(s) of: Resident care and related services. Number of residents present at the facility at the beginning of the inspection: 19 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 2 Number of staff records reviewed: 5 Number of interviews conducted with residents: 0 Number of interviews conducted with staff: 1 Observations by licensing inspector: Additional Comments/Discussion: An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation supported the self-report of non-compliance with standard(s) or law, and violation(s) were issued. Any violation(s) not related to the self-report 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 Becky Berry, Licensing Inspector at 276-608-3514 or by email at rebecca.berry@dss.virginia.gov.

Violations:

Standard #:	22VAC40-73-650-A
Description:	Based on facility self-report, documentation review and interview with staff, the facility failed to ensure no medication, dietary supplement, diet, medical procedure, or treatment shall be started, changed or discontinued by the facility without a valid order from a physician or other prescriber. EVIDENCE: 1. LI received a report from staff #1 on 04/06/2023 stating staff #5 reported to staff #4 at approximately 3:55am the same date that an agency nurse (staff #3) stated she gave 10mg Melatonin to residents #1 and #2. Per staff #1, this medication was not ordered by a prescriber for the above referenced residents. 2. Per the Medication Administration Records (MARs) and prescriber orders, resident #1 receives Melatonin Tablet 5mg, give 5mg by mouth at bedtime for insomnia and resident #2 receives Melatonin Oral Tablet 3mg, give 1 tablet by mouth at bedtime for insomnia. 3. Per interview with staff #1, the prescribed Melatonin for both resident #1 and resident #2 is packaged by the pharmacy in strip packaging, along with other prescribed medications for each resident. Staff #1 reported she did not know where the additional Melatonin came from. 4. Per written statement by staff #3, she gave resident #2 an additional 3mg of Melatonin ?with the intention of helping him sleep.? 5. Per written statement by staff #4, staff #5 reported that when he questioned staff #3 about administering ?medications that weren?t prescribed,? staff #3 stated it was not an issue because it was ?an over-the-counter medication.? Staff #5 also reported to staff #4 that staff #3 had given resident #1 ?extra melatonin out a separate supply in a bottle ? he did not know where the supply came from but thought he heard the nurse say it was 10mg.? 6. Per written statement by staff #5, he was asked by staff #3 to stay with resident #2, ?cause she had given him a Melatonin.? In addition, staff #5 also stated with regard to resident #1, staff #3 ?had taken melatonin out of an over-the-counter bottle and gave her one from it as well.? 7. Per written statement by staff #6, staff #6 witnessed staff #3 administer additional Melatonin to both resident #1 and resident #2.
Plan of Correction:	1.) In-service/education provided to all staff regarding mandated reporters, resident rights, and abuse, neglect, exploitation, and misappropriation of property. 2.) In-service/education provided to all nursing staff with policies and procedures on abuse, neglect, exploitation and misappropriation, use of restraints, medication utilization, administrating medication, medication errors, documentation of medication administration, medication administration schedule, labeling of medication, administrating oral medications, and medication orders. 3.) Agency nurse was placed on do not return to this facility with her agency.