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: Nov. 1, 2023 , Nov. 21, 2023 , Jan. 9, 2024 and Feb. 9, 2024

Complaint Related: No

Areas Reviewed:

22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS

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: 11/01/2023 4:35pm to 5:05pm, 11/21/2023 12:54pm to 1:03pm, 01/09/2024 10:45am to 11:24am, and 02/09/2024 11:47am to 11:53am. 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 10/30/2023 regarding allegations in the area(s) of: Resident care and related services, general supervision and care. Number of residents present at the facility at the beginning of the inspection: 18 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 1 Number of staff records reviewed: N/A Number of interviews conducted with residents: 0 Number of interviews conducted with staff: 3 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 #:	22VAC40-73-460-D
Description:	Based on staff and collateral interviews, the facility failed to provide attention to specialized needs such as wandering from the premises. EVIDENCE: 1. Resident #1 was admitted to the safe secure unit on 10/27/2023 due to information on the physical examination dated 10/12/2023 which states that she is non-ambulatory, and a physician?s statement dated 10/26/2023 that says resident #1 has a serious cognitive impairment due to a primary psychiatric diagnosis of dementia and is unable to recognize danger. 2. The licensing inspector (LI) received an incident report from staff #1 on 10/30/2023 stating resident #1 was found outside the facility the same date. Staff #1 reported she was notified regarding the incident at approximately 9:30am and by that time, resident #1 was back inside the facility. Staff #1 estimated resident #1 exited the safe secure unit unaccompanied at approximately 9:20am. 3. The individualized service plan (ISP) for resident #1, dated 10/27/2023, includes the description of the need for assistance with mobility, human supervision. In the section entitled ?Services to be Provided,? the ISP states ?Resident will always be supervised when resident leaves the Memory Care Unit.? The section entitled ?Expected Outcomes and Time Frames? states ?Resident will be continuously supervised when off Memory Care Unit through 10/27/2024.? 4. When facing the building, the assisted living facility/safe secure unit is on the right side, and a skilled nursing facility occupies the left side. The two facilities are connected by a common lobby area in the middle. 5. Per the report, collateral #1 observed resident #1 outside the facility on 10/30/2023 and came over to the safe secure unit to notify the charge nurse. Collateral #1 reported to the LI during an interview on 11/01/2023 that she observed resident #1 on the sidewalk in front of the building through a window on the skilled nursing side of the building. 6. Staff #2 reported to LI during phone interview on 11/14/2023 she observed resident #1 outside on the sidewalk in front of the building, after being notified that resident #1 was outside the facility. 7. Staff #3 reported to LI during a phone interview on 11/14/2023 that she went outside after being notified that resident #1 was outside the facility, and observed resident #1 exiting the hotel located across from the facility. Staff #3 reported resident #1 came out one of the front doors of the hotel, to the left of the main entrance. Staff #3 stated she administered morning medications to resident #1 during breakfast in the dining area, at approximately 8:40am. 8. The hotel and the facility face one another, and each building has a parking lot in front. The parking lots of the two buildings are separated by a grassy median. 9. Per staff #1, it was determined that an outside service provider had let resident #1 out of the safe secure unit as she was coming in. The facility sign-in sheet indicates the outside service provider entered the building at 9:18am. Staff #1 reported the outside service provider entered the building, dropped off supplies on the skilled nursing side and came over to the safe secure unit briefly to ask a question. 10. Per accuweather.com, the high temperature outside on 10/30/2023 was 67 degrees Fahrenheit and the low temperature was 44 degrees Fahrenheit. Per wunderground.com, the temperature at 8:53am on 10/30/2023 was 44 degrees Fahrenheit and at 9:53am the temperature was 50 degrees Fahrenheit. Per staff #1, resident #1 was fully dressed while she was outside, including shoes and a cardigan. Staff #1 estimated that resident #1 was outside for no more than 10 minutes.
Plan of Correction:	1.) Memory Care unit entrance door code was changed immediately and was made a practice that only in house employees will have the code from now on. 2.) Inservice education was provided to all Memory Care staff regarding wandering and elopement and missing persons. 3.) Elopement binder at reception desk was updated to include resident #1 photo and wandering risk assessment. 4.)Resident #1 Uniform Assessment Instrument and Individual Service Plan was updated on 10/30/23 to include behavior patterns of ?wandering/Passive-Weekly or more with exit seeking behaviors?. 5.) Signage was placed at entrance to Memory Care for those entering to be on alert for residents and procedure for entrance if needed. [SIC]