VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Heatherwood Independent and Assisted Living
9642 Burke Lake Road
Burke, VA 22015
(703) 425-1698

Current Inspector: Jacquelyn Kabiri (703) 397-3017

Inspection Date: April 22, 2019

Complaint Related: No

Areas Reviewed:

22VAC40-73 GENERAL PROVISIONS 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 63.2 General Provisions. 63.2 Protection of adults and reporting. 63.2 Licensure and Registration Procedures 63.2 Facilities and Programs.. 22VAC40-90 Background Checks for Assisted Living Facilities 22VAC40-90 The Sworn Statement or Affirmation 22VAC40-90 The Criminal History Record Report 22VAC40-80 THE LICENSE.

Comments:

An unannounced renewal inspection was conducted on 4/22/19 (7:50 AM - 6:00 PM). At the time of entrance, 114 residents were in care. Meals, medication administration and activities were observed. Building and grounds were inspected and records were reviewed. The sample size consisted of 10 resident records and five staff records. Violations were discussed and an exit meeting was held. Violations were discussed and an exit meeting was held. Areas of non-compliance are identified on the violation notice. Please complete the 'plan of correction' and 'date to be corrected' for each violation cited on the violation notice and return to the licensing office within 10 calendar days. Please specify how the deficient practice will be or has been corrected. Just writing the word 'corrected' is not acceptable. The 'plan of correction' must contain: 1) Steps to correct the non-compliance with the standards, 2) Measures to prevent the non-compliance from occurring again, and 3) Person responsible for implementing each step and/or monitoring any preventative measures. Thank you for your cooperation and if you have any questions, please contact me via e-mail at m.massenberg@dss.virginia.gov.

Violations:

Standard #:	22VAC40-73-50-B
Description:	Based on record review, the facility failed to ensure that the written acknowledgment of the receipt of the disclosure document is retained in the resident record. Evidence: The written acknowledgment, of the receipt of the disclosure document, was not present in 3 out of 6 resident records (Residents #3, 7, and 8).
Plan of Correction:	All resident files were audited to ensure that a written acknowledgement of disclosure document is in place. All future resident admission files will be reviewed by the Community Relations Director and/or Executive Director to ensure acknowledgement of disclosure document is present.
Standard #:	22VAC40-73-70-C
Description:	Based on record review, the facility failed to ensure that a written report of each serious incident is reported to the regional licensing office within seven days from the date of the incident. Evdidence: Resident #8's record was reviewed during the inspection. A note, in Resident #8's record, stated that the resident was observed to have a stage II pressure injury on 3/28/19. On 4/2/19, Resident #8 fell and sustained an injury to her forehead. The resident was then transported to the hospital. No reports were made to the licensing office, regarding these incidents.
Plan of Correction:	The Executive Director and the Wellness Director will provide additional training to all nursing staff instructing the team to notify the Executive Director and Wellness Director of all potential reportable incidents. The Executive Director or designee will notify DSS according to standard 22- VAC 40-73-70 as needed.
Standard #:	22VAC40-73-680-D
Description:	Based on record review, the facility failed to ensure that medications are administered in accordance with the physician's instructions and consistent with the standards of practice outlined in the current registered medication aide curriculum approved by the Virginia Board of Nursing. Evidence: A note in the record for Resident #1 stated that, on 11/3/18, the resident was given Resident #11's Omeprazole, ordered 10/28/18. No order for Omeprazole was found in the record for Resident #1. The UAIs for Resident #1 (10/16/18) and Resident #11 (10/16/18) state that the residents need their medications to be administered by facility staff.
Plan of Correction:	1. Medication error policy was followed after medication error occurred. Heatherwood Wellness Director will provide all RN, LPN and medication technicians with training regarding accurate and proper medication administration procedures. Date to be corrected - 6/1/19.
Standard #:	22VAC40-73-680-M
Description:	Based on observation and record review, the facility failed to ensure that PRN medications are available and properly stored at the facility. Evidence: PRN Zofran and Cyclobenzaprine, ordered for Resident #12, were not present at the time of the medication cart inspection. No orders discontinuing the medications were found in the resident record.
Plan of Correction:	MAR to cart audits will be completed weekly by a licensed nurse and quarterly medication cart audits by pharmacy will continue. These audits will be reviewed by the Wellness Director or Assistant Wellness Director. Any medications not available will be ordered immediately from the pharmacy.