VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Memory Lane Assisted Living
123 Lakeview Drive
Woodstock, VA 22664
(540) 459-3738

Current Inspector: Jeffrey Marnien (540) 571-0189

Inspection Date: May 16, 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 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS Article 1 Subjectivity 32.1 Reported by persons other than physicians 63.2 Protection of adults and reporting. 22VAC40-90 Background Checks for Assisted Living Facilities 22VAC40-90 The Sworn Statement or Affirmation 22VAC40-90 The Criminal History Record Report

Technical Assistance:

1. New administrator will need 12 hours of dementia training within 3 months; 2. Reviewed location of web site documents/templates with new administrator; 3. Licensing will forward templates for medication management and infection control plan templates; and 4. Licensing will notify new administrator of next Phase II training. Census: 22 12pm-3:30pm (Two Inspectors)

Comments:

The information contained in this renewal inspection report will be reviewed by the licensing administrator. The facility will be notified by mail regarding their renewal status. Three violations were identified during this unannounced renewal inspection. They were in the areas of staff training and medication administration as it relates to physician orders and documentation. Details can be found in the violation portion of this report. The facility was clean and odor free. Individuals were observed having lunch and an afternoon snack. All appeared to meet dietary requirements and physician orders. Ample staff were available to assist those who needed extra help eating. Outside inspections were current as were related drills. The pharmacy review was current and follow-up of recommendations had been completed with physician. There were no concerns raised by residents or families. There have been no complaints during this licensing period. Thank you to residents, families and staff for your cooperation during this renewal inspection process. Should have additional comments or concerns please call (5400 332-2330 or e-mail this inspector at sharon.deboever@dss.virginia.gov.

Violations:

Standard #:	22VAC40-73-1140-B
Description:	Based on a review of staff training records, staff were not receiving 10 hours of training in cognitive impairments during the first four months of employment.
Plan of Correction:	The facility depends in great part on the online program Reliance for training. Administrative staff will work with the system to ensure that the required training is in the initial training package for new staff. It is understood that all staff who will potentially work in the memory care unit must have these hours of training. Those staff will be required to update their training thru Reliance. Documentation will be maintained accordingly. The new administrator will work with human resources office to ensure correction and future compliance. The "date to be corrected" represents an initiation date for this process.
Standard #:	22VAC40-73-680-I
Description:	Based on a review of a random sample of medication administration records (MARs), the following was identified as not being in compliance as required by the standard: Resident A: duplicate orders for ativan and morphine, both as needed/PRN, no initials for removing ted hose, applying ointment or supervising the meal the evening of May 8, and oxygen source not identified; Resident F: order for reglan states before meals but is scheduled at meal time, and order for robafen for mucous and cough four times a day started 5/2/19 with no indication of a review or stop date; Resident G: No documentation of colostomy care the evening of May 1; and Resident H: receives psychotropic medication for various behaviors - documentation reflects side effects and/or ineffectiveness of medication with no follow-up noted.
Plan of Correction:	Administrator will work with nursing staff on issues related to documentation on the MARs. Source for all residents receiving O2 will be added. Medication administration times will be adjusted as applicable. Clarification and training will also be provided as it relates to documentation for the administration of psychotropic medication. A copy of the medication plan template has also been requested from licensing for future training purposes. The new administrator assumes responsibility for correction and future compliance.
Standard #:	22VAC40-73-680-K
Description:	Based on a review of a random sample of medication administration records (MARs), there was not information included in the physician's orders what to do if symptoms persist or how much to administer in a twenty-four hour period consistently for as needed/PRN medication.
Plan of Correction:	Physician's orders will be reviewed and a statement added that incorporates the required information. It is understood that unless there is something specific for a medication the physician may write a statement to cover all PRN medications. The new adminisrator will work with the physicians and nursing staff to ensure correction and future compliance,