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Cary Adult Home
7336 Cary Avenue
Gloucester, VA 23061
(804) 693-7035

Current Inspector: Willie Barnes (757) 439-6815

Inspection Date: May 18, 2017 and May 19, 2017

Complaint Related: No

Areas Reviewed:
63.2-1805-A-9 Requiring that each assisted living facility prepare and provide a statement, in a format prescribed by the Board, to any resident or prospective resident and his legal representative, if any, and upon request, that discloses whether the assisted living facility maintains liability insurance in force to compensate residents or other individuals for injuries and losses from the negligent acts of the facility, provided that no facility shall state that liability insurance is in place unless such insurance provides a minimum amount of coverage as established by the Board; and
22VAC40-72 ADMINISTRATION AND ADMINISTRATIVE SERVICES.
22VAC40-72 PERSONNEL.
22VAC40-72 STAFFING AND SUPERVISION.
22VAC40-72 ADMISSION, RETENTION AND DISCHARGE OF RESIDENTS
22VAC40-72 RESIDENT CARE AND RELATED SERVICES
22VAC40-72 RESIDENT ACCOMMODATIONS AND RELATED PROVISIONS.
22VAC40-72 BUILDINGS AND GROUNDS.
22VAC40-72 EMERGENCY PREPAREDNESS.

Comments:
A renewal study was conducted at Cary Avenue Adult Home on May 18, 2017 and May 19, 2017. The purpose of inspection is to conduct an unannounced review of this facility with a primary focus on the above standards. (12:45 P.M. - 5:15 P.M.) There were 57 residents in care. Observations, reviews of facility's records and interviews with residents and staff members were conducted during this inspection visit. Violations cited were discussed with the administrator.

Violations:
Standard #: 22VAC40-72-670-H
Description: Based on records review, the facility did not have proper documentation on the medication administration records (MARs) of Residents #1, #2 and #3. Evidence: On 5/18/2017, LI observed Staff #1 administering the 2:00pm medication for four residents. 1. A review of the MARs for Resident #1 revealed that the diagnoses were missing for the following medications: Aspirin EC 81mg Tablet, Atorvastan 80 mg Tablet, Benztropine MES 1 mg Tablet, Buspirone 10 mg Tablet, Divalproex ER 250 mg, Divalproex SOD ER 500 mg DNC Tablet, Furosemide 20 mg Tablet, Humalog 100 u/ML Kwikpen, Metformin HCL 1000 mg Tablet, Metoprolol Tartrate 25 mg Tab, Risperidone 2 mg Tab, Saphris 10 mg SL Tab BLK CHR, Trifluoperazine 1mg Tab, and Viibryd 40 mg Tab. 2. A review of the MARs for Resident #2 revealed that the diagnoses were missing for the following medications (May 2017): for Aspirin Child 81mg Tab Chew, Dicyclomine 10 mg Capsule, Ear Wax Drops 6.5%, Gabapentin 300 mg Capsule, Hydrocodone/APAP 5/325 Tab, Perphenazine 2 mg Tablet and Phazyme 180 mg Softgel Cap. 3. A review of the MARs for Resident #2 revealed that the diagnosis missing for Aspirin Child 81mg Tab Chew.

Plan of Correction: Administrator contacted pharmacy to review all diagnoses on the MARs and to ensure each medication has a diagnosis. Administrator will audit MARs monthly to ensure compliance with the standard.

Standard #: 22VAC40-72-850-A
Description: Based on observation during physical plant tour, the facility failed to have its interior in good repair. Evidence: On 5/18/2017, licensing inspector observed with staff two-inch hole in diameter in the laundry room. The sprinkler head cover is not flushed to the ceiling leaving a 1/2 inch crack (in need of repair).

Plan of Correction: Maintenance repaired hole in the laundry room on May 22, 2017. The manager will conduct weekly preventive maintenance checks to ensure compliance with the standards

Disclaimer:
A compliance history is in no way a rating for a facility++.

The online compliance history includes only information after July 1, 2003. In addition, the online compliance history includes information regarding adverse actions that may be the subject of a pending appeal. An adverse action is not final until a provider has exhausted or waived all due process rights. For compliance history prior to July 1, 2003, or information regarding the status of pending adverse actions, please contact the Licensing Inspector listed in the facility's information. The Virginia Department of Social Services (VDSS) is not responsible for any errors in or omissions from the compliance history information.

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