VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Commonwealth Senior Living at King's Grant House
440 North Lynnhaven Road
Va. beach, VA 23452
(757) 431-8825

Current Inspector: Margaret T Pittman (757) 641-0984

Inspection Date: April 3, 2019

Complaint Related: No

Areas Reviewed:

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

Comments:

An unannounced monitoring inspection was conducted by the Licensing Inspector from the Eastern Regional Office on 04-03-2019 from 10:20 AM to 11:40 AM. There were 69 residents in care at the time of the inspection. The following was reviewed by the LI:1 resident record,1 staff record, staff training, video footage, and facility policies. The following was discussed with the Administrator during the inspection: Staff training on handling residents with dementia and/or residents with aggressive behaviors. The facility received a violation "under" Resident Care and Related Services. The area of noncompliance was discussed with the Administrator throughout the inspection and during the exit interview. Please complete the "plan of correction" and "date to be corrected" for each violation cited on the Violation Notice within 10 days of today's date, on 04-27-2019. You will need to specify how the deficient practice will be or has been corrected. Just writing the word "corrected" is not acceptable. Your plan of correction must contain: 1. Steps to correct the noncompliance with the standard(s) 2. Measures to prevent the noncompliance from occurring again; and 3. Person (s) responsible for implementing each step and /or monitoring any preventive measure(s).

Violations:

Standard #:	22VAC40-73-550-C
Description:	Based on observation, record review, and interview, the facility failed to ensure residents of an assisted living facility have the rights and responsibilities as provided in A? 63.2-1808 of the Code of Virginia to include the right to be free from physical abuse. Evidence: 1. On 03-28-2019, the Licensing Inspector (LI) received a 24 hour incident report from the facility regarding a ?staff to resident altercation? involving resident #1. The 7 day incident report was sent to LI on 04-01-2019 which stated, ?Direct care staff associate entered memory care neighborhood, resident was standing behind the door and tried to strike staff in the head. Staff member pushed resident back and resident fell to the floor.? 2. On 04-03-2019, staff #1 provided LI with the video footage of the incident dated 03-27-2019. Review of the video footage with staff #1 revealed the following: resident #1 was standing by the entrance door of the special care unit (SCU), staff #2 entered the SCU; staff #2 raised her left arm into the air, resident #1 grabbed staff #2?s arm; resident #1 reached up and placed both of her hands onto staff #2?s face; staff #2 pushed resident #1; the resident fell onto the floor and hit her head on the wall; staff #2 looked at resident #1 on the floor and then walked away. LI did not observe resident #1 attempt to strike staff #1 in the head; as documented in the incident report dated 04-01-2019. 3. In addition, staff #1 provided LI with staff #3?s written statement; ?On 03-27-2019.. staff #2 came to me while I was on Assignment 3 hallway in the closet getting personal items for another resident and stated ?I know your about to send me home because of what I just did. Then she stated that as she was coming into the entry of sweet memories, resident #1 was standing in the doorway and hit her with a plastic cup in her face and she reacted by pushing the resident on the floor. As I walk around to the first hallway by the entrance of Sweet Memories I observed resident #1 on the floor?? 4. Staff #1 provided LI with the facility?s ?Abuse, Prevention, Intervention, Reporting, and Investigation? policy dated 02-01-2019 which states, ?Resident abuse, neglect, and exploitation are prohibited?. Residents are to be fee from verbal, sexual, physical, emotional/mental abuse, neglect, self-abuse/self-neglect, medical neglect, misappropriation of resident property, corporal punishment, and involuntary seclusion at all times.? 5. During staff #2?s record review, the Counseling/Disciplinary Notice form dated 03-28-2019 revealed staff #2 was terminated for ?Gross Misconduct? due to ?Committing any physical, verbal, or mental abuse of a resident, either by act or omission.? The Counseling/Disciplinary Notice form indicated ?On March 27, 2019 at 8:22pm, staff #2 entered the memory care neighborhood. A female resident was standing in the door way. The resident tried to strike staff #2 in the head, staff #2 pushed the resident causing her to fall and hit her head on the wall. Staff #2 left the resident on the floor and went to the RMA on duty to advise of the incident. The RMA directed staff #2 to clock out and leave the property.? 6. During interview, staff #1 acknowledged that staff #2 pushed resident #1 to the ground and left the resident there as staff #2 walked away.
Plan of Correction:	Associate was terminated and incident report submitted to APS and DSS as per DSS Licensing Standards and Mandated Reporting. Resident Care Director or designee to in-service all associates on Resident Rights and Resident Abuse Prevention policy. Executive Director, Resident Care Director, Assistant Resident Care Director, or designee will continue to monitor provision of care to ensure compliance.