VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Banister Residential Care Facility, Inc.
1017 Bethel Road
Halifax, VA 24558
(434) 476-8811

Current Inspector: Cynthia Jo Ball (540) 309-2968

Inspection Date: April 18, 2019

Complaint Related: No

Areas Reviewed:

22VAC40-73 RESIDENT CARE AND RELATED SERVICES

Comments:

This monitoring visit resulted from violations received at the renewal study in January 2019. At 12:17 pm the inspection commenced and concluded at 1:58 pm. Three violations were cited, with two being repeat violations. Eight residents were in care. During the inspection, the LI reviewed resident records and conducted interviews. After the inspection, the LI and staff reviewed the violations and provided an opportunity for open discussion. Please complete the ?plan of correction? and ?date to be corrected? for each violation cited on the violation notice and return it to your licensing inspector within 10 calendar days from today. 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 the following: 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 #:	22VAC40-73-640-A
Description:	Based on documentation review and staff interview, the facility failed to implement the medication management. Evidence: 1. In April 2019, the individual controlled drug inventory does not ensure accurate counts of all controlled substances whenever assigned medication administration staff changes. There is no medication count occurring at shift change. Staff 1 confirmed the facility was not in compliance with this standard. 2. Resident 1 is prescribed Gabapentin three times a day. In February 2019, resident 1 did not receive at least one dose on 2/23, 2/24, 2/25, 2/26, 2/27 & 2/28 due to "waiting on refill". In March 2019, resident 1 did not receive at least one dose on 3/1, 3/2, 3/3, 3/4, 3/5, 3/6 & 3/7 due to "waiting on a refill". Resident 1 is prescribed Febuxostat once a day. In April 2019, resident 1 did not receive the dose on 4/10, 4/11, 4/12, 4/13, 4/14, 4/15, 4/16, 4/17 & 4/18. Resident 1 is prescribed Clonazepam twice a day. In April 2019, resident 1 did not receive at least one dose on 4/17 & 4/18. Staff 1 confirmed the facility was not in compliance with this standard. 3. Resident 3 is prescribed artificial tears three times a day. In February 2019, resident 3 did not receive at least one dose on 2/8, 2/9, 2/10, 2/11, 2/12 & 2/13. Staff 1 confirmed the facility has no documentation indicating the physician was notified about resident 3 refusing medications for 6 consecutive days. Staff 1 confirmed the facility was not in compliance with this standard since the responsible medication aide or the person licensed to administer drugs did not routinely communicate issues or observations related to medication administration to the prescribing physician or other prescriber.
Plan of Correction:	1. The administrator shall have a form to ensure the accurate county of controlled substances at the beginning and ending of each shift requiring two initials for each shift change. 2. The administrator shall implement in her medication management plan steps to follow when a resident medications come through the mail. Allow enough time to be delivered before the last dose is taken. 3. The administrator shall implement in the medication management policy and procedures steps to follow when a resident is refusing medication for a few days. Contact the Physician and explain the reason for refusal, have an order if changes were made document on Mar and communication log as well as verbal talking with the following staff member to avoid miscommunication concerning the well being of the resident.
Standard #:	22VAC40-73-680-C
Description:	Based on document review and staff interview, the facility failed to ensure medications are administered not earlier than one hour before and not later than one hour after the facility's standard dosing schedule, except those drugs that are ordered for specific times, such as before, after, or with meals. Evidence: 1. Resident 4 is prescribed Colace twice a day. The standard dosing schedule is 8 am and 8 pm. On 4/3/19 at 3 am, staff 2 administered the medication outside the administration time frame. Staff 1 confirmed the facility was not in compliance with this standard.
Plan of Correction:	1. The administrator shall implement in the plan for medication management that medication shall not be given out the facility standard dosing time. Not more than an hour early or an hour later than the facility standard dosing unless have ordered by a physician with a specific time to stay in compliance with this standard.
Standard #:	22VAC40-73-680-I
Description:	Based on residents' records review, the facility failed to ensure MAR documentation included all the required components. Evidence: 1. Resident 2 is prescribed vitamin D3. On 3/31/19, the MAR indicates there is an error. The MAR notes does not indicate details about the error. Staff 1 confirmed the facility was not in compliance with this standard. 2. Resident 3 is prescribed artificial tears. On 2/11/19 & 2/12/19, staff 2 did not indicate the reason for circling initials. It is unclear if the resident received the medication or not. On 4/18/19, the LI and staff 1 were reviewing the MAR at 1:21pm. The 3 pm dosage was initialed as given. Staff 1 confirmed it was marked as administered in error and was not administered. 3. Resident 4 is prescribed cough DM PRN. The MAR indicates the 4/3/19 administration initials were an error but does not indicate the reason for the error. Resident 4 is prescribed Promethazine twice daily. In April 2019, the MAR indicated the medication was administered on 4/2, 4/8, 4/12 & 4/13 but does not indicate the dosage, reason or results/response. Resident 4 is prescribed artificial tears. On 4/14/19 & 4/18/19, at least one dose had no administration documentation, the space is blank. It is unclear if the medication was administered or not. Resident 4 is prescribed duke magic mouthwash four times a day. On 4/18/19, the 5 pm & 8 pm doses were initialed and circled. The LI and staff 1 were reviewing the MAR at 1:14 pm. Staff 1 confirmed it was marked as administered in error. For both artificial tears and duke magic mouthwash, the April 2019 MAR was missing the reason for circling initials on 4/10, 4/11, 4/12, 4/13, 4/14, 4/15, 4/16 & 4/17. Staff 1 confirmed the facility was not in compliance with this standard. 3. Resident 6 is prescribed febuxostate. On 4/11/19, the MAR has circled initials. The MAR notes do not indicate why the initials were circled. It is unclear if the medication was administered or not. Staff 1 confirmed the facility was not in compliance with this standard.
Plan of Correction:	1. The administrator implement a plan of action in the medication management policy and procedure that when an error is made on MAR to document and explain the reason for the error on the MAR initial date it. 2. The administrator shall implement in the medication management policy and procedures that the MAR should not be signed until you are ready to administer medications to avoid errors or mistakes. 3. The administrator shall implement in the medication management policy and procedures when administering PRN that you must complete the back of the MAR with date, time, name of medication, dosage, reason it is given, results after talking with the resident, the time you got the results and staff initials. The staff shall keep the MARs located on the nurse desk when the MARs comes in monthly and if a resident is missing their MAR for that month staff are to contact the pharmacy to have on sent out to the facility. Step to this procedure will be added to plan of medication management. 4. The administrator shall routinely check the MARs for errors and mistakes and discuss it with the staff. The administrator shall also routinely monitor when staff is administering medications on each shift.