VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Hills Home for Adults
1443 Commerce Avenue
Chesapeake, VA 23324
(757) 545-8797

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

Inspection Date: May 13, 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 05-13-2019 from 6:38 AM to 10:17 AM. There were 43 residents in care at the time of the inspection. 5 residents were observed during a medication pass and physician's orders were reviewed. 1 staff record was reviewed and 1 staff record requested not available for review. Staff schedules were also reviewed. The Administrator was not present during the inspection. The following was discussed with the staff person in charge: ensuring staff are aware of the location of PRN medications on the medication cart and ensuring current physician's orders and staff records are on file. The areas of non-compliance were reviewed throughout the inspection and during the exit interview. The facility received violations "under" Personnel and Resident Care and Related Services. 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 06-01-2019. 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 measure.

Violations:

Standard #:	22VAC40-73-250-B
Description:	Based on record review and interview, the facility failed to ensure all staff records are retained at the facility. Evidence: 1. During staff record review with staff #2, the Licensing Inspector requested to see staff #4?s record; however, staff #2 was unable to produce staff #4?s record. 2. During review of the March, April, and May 2019 staff working schedule, staff #4 was scheduled to work as a PCA (personal care aide) on the following days: a. 03-15-2019 through 03-19-2019; 03-22-2019; 03-23-2019; 03-25-2019; 03-26-2019; 03-29-2019; and 03-30-2019. b. 04-01-2019; 04-05-2019; 04-06-2019; 04-08-2019; 04-09-2019; 04-12-2019; 04-13-2019; 04-15-2019; 04-22-2019; 04-26-2019; 04-27-2019; 04-29-2019; and 04-30-2019. c. 05-03-2019; 05-04-2019; 05-06-2019; 05-07-2019; 05-10-2019; 05-11-2019; 05-13-2019; 05-14-2019; 05-17-2019; 05-18-2019; 05-20-2019; and 05-21-2019. 3. During interview, staff #2 stated there was ?no record on file for staff #4.?
Plan of Correction:	Hill's Home for Adults will make sure that their employees have the required documentation as per state policy. Hill's Home for Adults will make sure that the required documentation is in the staff chart. Hill's Home for Adults Office Manager, along with Mr. Hill will continue to make sure that the required documentation is in the staffs chart by periodically checking the staff charts.
Standard #:	22VAC40-73-650-A
Description:	Based on observation, record review, and interview, the facility failed to ensure no medication, was started by the facility without a valid order from a physician or other prescriber. Evidence: 1. During the morning medication pass observation with staff #1, the Licensing Inspector (LI) observed staff #1 administering medications to resident #5 to include 1 cap of Linzosa (Linzess) 145mcg for constipation. 2. During resident #5?s record review with staff #2, the resident had a script dated 04-23-2019 for ?Linzess Capsule 145mcg (Linaclotide) Give 1 capsule by mouth on time a day for constipation;? however, the script did not contain a signature from the physician or other prescriber. LI and staff #2 were unable to locate a signed physician?s order on file for the Linzess 145mcg capsule. 3. Upon further review of resident #5?s record review, the April and May 2019 Medication Administration Record revealed the resident received the Linzess 145mcg capsule from April 26, 2019 through May 13, 2019. 3. During interview, staff #2 confirmed the facility did not have a signed physician?s order on file for resident #5?s Linzess 145mcg capsule.
Plan of Correction:	Hill's Home for Adults will make sure that the current medications orders that are given are signed by the doctor. Hills Home for Adult Office Manager and Nurse will get the doctor to sign bi-weekly print outs of the residents physicians orders. Hill's Home for Adults Office Manager, along with Mr. Earl Hill will continue to make sure that the Physicians orders are signed by Hill's Home for Adult Medial Director Doctor.
Standard #:	22VAC40-73-680-D
Description:	Based on observation, record review, and interview, the facility failed to ensure medications are administered in accordance with the physician's or other prescriber'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: 1. During the morning medication pass observation with staff #1, at 6:49 AM LI observed staff #1 administering medications to resident #1 to include 1 tab of Sucralfate 1gm, without food. 2. During resident #1?s record review with staff #2, the resident had a current physician?s order on file dated 05-03-2019 which stated ?Sucralfate 1gm tablet- 1 tab by mouth four times a day, every day. Take one tablet by mouth four times daily with meals and at bedtime? for duodenal ulcer.? 3. During interviews, staff #1 indicated that breakfast is usually served around 8:30 AM or 9:00 AM. In addition. staff #2 confirmed resident #1?s aforementioned physician?s order dated 05-03-2019 was the most current order on file. 4. During the morning medication pass observation with staff #1, at 7:14 AM the Licensing Inspector (LI) observed staff #1 administering medications to resident #4 to include 1 tab of Fluphenazine 10mg. 5. During resident #4?s record review with staff #2, the resident had a current physician?s order on file dated 05-03-2019 which stated ?Fluphenazine 10mg tablet- 2 tab by mouth twice a day, every day? for schizophrenia.? LI and staff #2 were unable to locate a more current physician?s order file for the Fluphenazine 10mg tablet. 6. Upon further review of resident #4?s record, the May 2019 Medication Administration Record revealed the resident received 1 tab of Fluphenazine 10mg on 05-09-2019 through 05-13-2019. 7. During interview, staff #2 confirmed resident #4?s aforementioned physician?s order dated 05-03-2019 was the most current order on file. Staff #2 also acknowledged staff #1 did not administer the Fluphenazine 10mg to resident #4 in accordance with the physician?s instructions.
Plan of Correction:	HIll's Home for Adults will make sure that the residents are given the correct medications as prescribed by the doctor. Hills Home for Adult will start the new medications as prescribed by the doctor. Hills Home for Adult will start the new medication prescribed by the doctor once the medication is delivered to the facility by the Pharmacy. Hills Home for Adult Office Manager and Nurse will get the doctor to sign bi-weekly print outs of the residents physicians orders. Hill's Home for Adults Office Manager, along with Mr. Earl Hill will continue to make sure that the Physicians orders are signed by Hill's Home for Adults Medial Director Doctor.