VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Harmony at Independence
2077 South Independence Boulevard
Virginia beach, VA 23453
(757) 802-3665

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

Inspection Date: March 27, 2019

Complaint Related: No

Areas Reviewed:

22VAC40-73 RESIDENT CARE AND RELATED SERVICES

Technical Assistance:

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Comments:

An unannounced monitoring inspection was conducted on this date with co-worker A.P. from 9:40 a.m until 3:55p.m. A follow-up on ISPs was the primary focus of the inspection . There were 62 residents in care. A resident was observed receiving an afternoon medication. Interviews were conducted with staff residents and families . A new director of nursing was hired earlier this month and a new administrator will start soon. The staff was advised to monitor residents closely to ensure they remain appropriate for the building classification and the services identified and needed are being provided . Also staff were encouraged to monitor and document changes in needs, devices ,supplies, or medication orders and train and retrain staff as needed on the application of assistive devices. Documentation of hourly rounds should reflect the exact time . 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 measures

Violations:

Standard #:	22VAC40-73-450-E
Description:	Based on record review and interview the facility failed to ensure the updated individualized service plan of a resident was signed and dated by the resident or his legal representative. The plan shall also indicate any other individuals who contributed to the development of the plan, with a notation of the date of contribution. The title or relationship to the resident of each person who was involved in the development of the plan shall be included . Evidence 1. During the review of resident # 3's , 2-26-19 ISP , with staff # 1 and #2 , the inspectors found the following updates were noted on the ISP subsequent to the family's 2-26-19, signature and date: a. fall score identified 3-19-19, b. left shoulder immobilizer identified 3-19 c. the raised commode identified 3-20-19 2. The ISP had not been reviewed ,signed, and dated by the resident or legal representative as of the date of the inspection 3-28-19. 3. The staff confirmed the updated ISP had not been signed by the resident or legal representative.
Plan of Correction:	Signatures were obtained on the ISP of Resident #3. Qualified staff will obtain signatures when the ISP is updated. Qualified staff will conduct weekly audits for continued compliance. This will be overseen by the Health Care Coordinator and/or designee
Standard #:	22VAC40-73-450-F
Description:	Based on observation, record review, and interview the facility failed to ensure the individualized service plans was updated at as the condition of the residents changed. The update shall be performed by a qualified staff person and in conjunction with the resident and, as appropriate, with the resident's family, legal representative, direct care staff, case manager, health care providers, qualified mental health professionals, or other persons. Evidence 1. While reviewing the ISP of resident #1 with staff #1 and #2 , the inspector found the 2-21-19 , ISP had not been updated to reflect the recertification of wound care on the forehead and hands as noted by the skilled nursing note dated 2-20-19. The ISP identified wound care on 2-4-19 to the left shin and the right and left lower extremity. 2. During the tour, the inspectors observed resident # 4, with a right arm trough . While reviewing his ISP dated 2-27-19, the inspector found there was no mention of the right arm trough on the ISP. The inspectors were told due to right sided weakness the arm trough secures the resident's arm and keeps the arm from dangling uncontrollably while being transported by wheelchair. 3. Staff #1 and #2 acknowledged resident # 1 and # 4's ISPs had not been updated as required.
Plan of Correction:	The healthcare coordinator updated the ISP of resident #1 and #4 to reflect current needs. Qualified staff will monitor and update ISPs at the time the need is identified. Qualified staff will conduct weekly audits for continued compliance. This will be overseen by the Health Care Coordinator or/designee
Standard #:	22VAC40-73-450-H
Description:	Based on record review and interview the facility failed to ensure that the care and services specified in the individualized service plan (ISPs) were provided to residents Evidence 1. While reviewing resident#1's ISP with staff #1 and #2 , the inspector found the ISP identified hourly checks as a need on 2-19-19 .There was no documentation of completion of the hourly checks until 2-22-19. The facility failed to ensure the identified needed service was provided. 2.Resident #2?s ISP identified on 3-12-19 resident # 2 would be checked often on each shift to reduce falls as the resident was a fall risk. Also an incident report on March 09, 2019 was completed with an outcome stating that staff will check ?often on every shift to reduce falls.? Licensing Inspectors (LIs) reviewed the staff communication log from March 09,2019 to the date of the inspection (March 27, 2019) and observed there was no consistent documentation on file of the "often checks" or the daily checks identified on the 3-12-19 ISP. 3. The staff #1 acknowledged there was no documentation of the hourly checks identified on resident #1's ISP noted on file until 2-22-19. Also it was acknowledged the facility did not keep a log of checks specifically for #2.
Plan of Correction:	The Healthcare Coordinator will have the staff continue documentation of checks that were started on 2.22.19 for resident #1. The facility will ensure that documentation starts at the time the need is identified and the ISP is updated. This will be overseen by the Health care Coordinator and/or designee. Resident #2 was assessed by a qualified assessor and the checks for resident #2 have been discontinued and the Healthcare Coordinator updated the ISP to reflect the change