VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Bell's Residential Adult Care Home
3720 Deep Creek Boulevard
Portsmouth, VA 23702
(757) 397-5586

Current Inspector: Donesia Peoples (757) 353-0430

Inspection Date: March 29, 2019

Complaint Related: No

Areas Reviewed:

22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES 22VAC40-73 PERSONNEL 22VAC40-73 STAFFING AND SUPERVISION 22VAC40-73 ADMISSION, RETENTION, AND DISCHARGE OF RESIDENTS 22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-73 RESIDENT ACCOMODATIONS AND RELATED PROVISIONS 22VAC40-73 BUILDING AND GROUNDS 22VAC40-73 EMERGENCY PREPAREDNESS

Comments:

An unannounced mandated monitoring inspection was conducted by two Licensing Inspectors from the Eastern Regional Office on 03-29-2019 from 7:30 AM to 1:01 PM. There were 21 residents in care at the time of the inspection. A tour of the facility was conducted, water temperatures were sampled, and the emergency food and water supply was reviewed. LI observed 4 residents during the medication pass observation and reviewed the medication cart. An activity was conducted with 18 residents in attendance and breakfast was observed. 6 resident records and 3 staff records were reviewed. There were no new hires since the last inspection in March 2018. LI reviewed the following: First Aid kit, emergency preparedness plan/practices, fire drills, the dietary and health care oversight, menus, activity calendars, and staff schedules. The Administrator stated the facility does not currently have a resident council. The following was discussed with the Administrator: Health care oversight dates, restraints, ISP's, and resident rights. LI recommended for the staff to review the current standards regarding restraints and ISP's and to ensure forms that are used match the current regulations. The facility received violations "under" Administration and Administrative Services and Resident Care and Related Services. The areas on noncompliance were reviewed with the Administrator throughout the inspection and during the exit interview. Please complete the ?plan of correction? for each violation cited on the violation notice and return it to me within 10 calendar days from today, on 04-26-2019. You will need to specify how the violation will be or has been corrected. Just writing the word ?corrected? is not acceptable. Your plan of correction must include: 1. steps to correct the noncompliance 2. measures to prevent reoccurrences 3. person(s) responsible for implementing and monitoring each step of the corrective measures and / or the preventative measure.

Violations:

Standard #:	22VAC40-73-50-A
Description:	Based on record review, and interview, the facility failed to maintain and keep current the facility disclosure with regards to the general number of staff on each shift. Evidence: 1. During record review, the facility?s disclosure statement indicated that there are 6 staff (to include a ?Medication Aide, Personal Care, Administrator, Cook, and Housekeeper?) working on the 7:00 AM to 3:00 PM shift. The February 2019 and March 2019 written work schedules revealed the following staff was scheduled to work during the 7:00 AM to 3:00 PM shift: a. 2 staff on the following days: 02-09-19; 02-16-19; 02-17-19; and 02-23-19. b. 3 staff on the following days: 02-02-19; 02-03-19; 02-10-19; 02-24-19; 03-02-19; 03-03-19; 03-10-19; 03-17-19; 03-23-19; and 03-24-19. c. 4 staff on the following days: 02-06-19; 02-07-19; 02-08-19; 02-12-19; 02-15-19; 02-22-19; 03-01-19; 03-29-19; and 03-30-19. d. 5 staff on the following days: 02-04-19; 02-05-19; 02-11-19; 02-13-19; 02-14-19; 02-18-19; 02-20-19; 02-21-19; 02-25-19; 03-08-19; 03-09-19; 03-11-19; 03-15-19; 03-16-19; 03-18-19 through 03-22-19; and 03-25-19. 2. During interview, staff #1 acknowledged the aforementioned written work schedules were not reflective of the facility?s disclosure statement.
Plan of Correction:	The Administrator or designee will revise the facility disclosure statement to reflect the correct number of staff on duty at each shift.
Standard #:	22VAC40-73-450-A
Description:	Based on record review and interview, the facility failed to ensure on or within seven days prior to the day of admission, a preliminary plan of care was developed to address the basic needs of the resident that adequately protects his health, safety, and welfare. The preliminary plan should be identified as such and be signed and dated by the licensee, administrator, or his designee (i.e., the person who has developed the plan), and by the resident or his legal representative. Exception: A preliminary plan of care is not necessary if a comprehensive Individualized Service Plan (ISP) is developed, in conformance with this section, on the day of admission. Evidence: 1. During resident record review with staff #1 and staff #2, the following ISP?s were not developed on or within seven days prior to the day of admission to the facility: a. Resident #2 admitted to the facility on 07-25-2019. The comprehensive ISP on file was dated 07-27-2019. b. Resident #3 admitted to the facility on 02-22-2019. The preliminary ISP on file was dated 02-26-2019 and the comprehensive ISP was dated 03-20-2019. 2. During interview, staff #2 confirmed resident #2?s ISP was the comprehensive ISP, and resident #3?s ISP?s were the preliminary and comprehensive ISP?s. 3. Staff #1 and staff #2 acknowledged resident #2 and resident #3?s aforementioned ISP?s were not developed within the required timeframe.
Plan of Correction:	In accordance with the requirements of the new regulations, the Administrator or designee will ensure all preliminary and comprehensive ISP?s are completed, and signed and dated by all parties within the required timeframe.
Standard #:	22VAC40-73-710-C
Description:	Based on observation, record review, and interview, the facility failed to ensure if a restraint is used, it must be imposed in accordance with a physician's written order that specifies the circumstances and duration under which the restraint is to be used. Evidence: 1. During the tour of the facility with staff #1, the Licensing Inspector (LI) observed a half side rail located on resident #4?s bed. 2. During resident #4?s record review with staff #1, the resident had a current physician?s order dated 09-28-2017 for a ?semi- electric hospital bed w/ half rails; Dx: Dementia/unstable gait.? The order did not specify the circumstances and duration under which the half side rail is to be used for. 3. Upon further review of resident #4?s record, the current Uniform Assessment Instrument (UAI) dated 06-08-2018 and the current Individualized Service Plan (ISP) dated 10-15-2017 revealed the resident does not walk, needs total assistance with wheeling, and needs assistance from staff to transfer from bed to wheelchair and wheelchair to chair. The ISP also stated, "Place resident in bed for rest/sleep or feeding; raise half rails to reduce occurrence of accidental falls from bed." In addition, the ISP indicated the resident ?has dementia and is oriented to self only? and needs assistance with short term and long term memory loss. 4. During interview, resident #4 was nonverbal and was unable to explain what the half side rail is used for, or how to use it. 5. During interview, staff #2 indicated the half side rail is used when resident #4 is eating or sleeping in bed. 6. Staff #1 and staff #2 acknowledged resident #4?s current physician?s order dated 09-28-2017 did not include the required specifications under which the half side rail is used for.
Plan of Correction:	The Administrator or designee will obtain a revised physician?s order for semi-electric hospital bed with half rails to include the circumstances and duration under which the half side rails will be used
Standard #:	22VAC40-73-710-D
Description:	Based on record review and interview, the facility failed to ensure whenever physical restraints are used, the facility should closely monitor the condition of the resident, which includes checking on the resident at least every 30 minutes. Evidence: 1. During resident #4?s record review with staff #2, the current Individualized Service Plan (ISP) dated 10-15-2017 revealed the half side rail is used when the resident is eating or sleeping in bed. The Licensing Inspector and staff #2 were unable to locate documentation on file to verify 30 minute checks are performed by staff when the half side rail is in use. 2. During interview, staff #2 indicated the staff checks on resident #4 during hourly rounds; however, the staff did not document 30 minute checks being performed.
Plan of Correction:	The facility has implemented 30-minute monitoring checks and documentation when hospital bed half rails are in use.
Standard #:	22VAC40-73-710-E
Description:	Based on observation, record review, and interview, the facility failed to ensure when restraints are used in non-emergencies, the following conditions are met: the physician?s orders are reviewed by the physician at least every three months and renewed if the circumstances warranting the use of the restraint continue to exist; restraints are used in accordance with the resident's service plan, to include a schedule or plan of rehabilitation training enabling the progressive removal or the progressive use of less restrictive restraints; and notify the resident's legal representative as soon as practicable, but no later than 24 hours after the initial administration of a non-emergency restraint. 1. During the tour of the facility with staff #1, the Licensing Inspector (LI) observed a half side rail located on resident #4?s bed. 2. During resident #4?s record review with staff #1, the resident had a current physician?s order dated 09-28-2017 for a "semi- electric hospital bed w/ half rails;" however, there were no additional orders on file to verify the half side rail was reviewed by the physician every three months. 3. Upon further review of resident #4?s record review, the current ISP dated 10-15-2017 revealed the resident uses a hospital bed with half side rail to reduce occurrence of accidental falls from bed; however, the ISP was not signed by the resident?s responsible party until 12-09-2017. In addition, the ISP did not include a schedule or plan of rehabilitation training enabling the progressive removal or the progressive use of less restrictive restraints. 4. During interview, staff #1 indicated there was no documentation on file to verify additional consent was given by resident #4?s responsible party at the time the facility implemented the half side rail. Staff #1 also acknowledged the facility did not have an additional physician?s order for the half side rail.
Plan of Correction:	The Administrator or designee will follow-up every three (3) months to obtain a physician?s order review for continued use of half side rail restraint for the duration of resident stay in the facility. The facility will obtain responsible party consent at the time the half side rails are implemented.