VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Harmony at Spring Hill
8350 Mountain Larkspur Drive
Fairfax, VA 22079
(571) 348-4970

Current Inspector: Amanda Velasco (703) 397-4587

Inspection Date: May 15, 2019 and May 16, 2019

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS Article 1 Subjectivity

Comments:

An unannounced complaint inspection was conducted on 5/15/19 and 5/16/19. The complaint, received by the licensing office on 5/3/19, concerned staffing and resident care/related services. The complaint was determined to be valid, as a preponderance of evidence gathered during the investigation supported the allegations. The violation was 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 #:	22VAC40-73-1130-A
Complaint related:	Yes
Description:	Based on documentation, the facility failed to ensure that when 20 or fewer residents are present, at least two direct care staff members are awake and on duty at all times in each special care unit. For every additional 10 residents, or portion thereof, at least one more direct care staff member shall be awake and on duty in the unit. The requirements in subsections A and B of this section are independent of 22 VAC 40-73-280 D and 22 VAC 40-73-1020 A. Evidence: The facility's direct care schedules were reviewed during the inspection. More than five residents were residing in the special care unit during the months of March, April and May. The facility also has a mixed care unit, that requires at least two staff to remain on duty, in the unit, at all times. Four direct care staff were scheduled as working on the night shift on 3/31/19, 4/2/19, 4/9/19, 4/12/19, and 4/26/19. There were not enough staff members to ensure appropriate staffing during break periods, on those dates.
Plan of Correction:	The Executive Director or designee will re-educate nursing leadership responsible for the clinical staff schedule creation and maintenance on the required staffing ratios for both memory care and assisted living. The posted schedule will reflect and mirror the daily assignment sheets. The posted schedule will indicate that the community has at least 2 direct care staff in the secure unit at all times, when 20 or fewer residents are present, and at least one more direct care member for every additional 10 residents, or portion thereof, who shall be responsible for the care and supervision of the residents. Additionally, the schedule will reflect adequate staffing to cover break times. The Healthcare coordinator or designee will review staff schedules daily at Standup to ensure sufficient staffing.
Standard #:	22VAC40-73-460-B
Complaint related:	Yes
Description:	Based on documentation, the facility failed to promptly respond to resident needs, as reasonable to the circumstances. Evidence: Facility call bell reports were reviewed during the inspection. The reports indicate that there were nine occasions when staff members took longer than 20 minutes to respond to Resident #1's call bell. The reports indicate that there were four occasions when staff members took longer than 20 minutes to respond to Resident#2's call bell.
Plan of Correction:	The Executive Director or designee will monitor Call Response/trends weekly and in-service Staff on Patient Safety and prompt response to call lights by 7/15/2019. The Executive Director or designee will review call response times daily at stand up and discuss the trends at monthly all staff meetings.
Standard #:	22VAC40-73-680-C
Complaint related:	Yes
Description:	The facility failed to ensure that medication is not administered more than an hour before, or one hour after, the facility's standard dosing schedule. Evidence: Medication administration information, from April and May, were observed during the inspection. Resident #1's medication was administered, more than one hour, after the facility's standard dosing schedule on: 4/2/19 (9 AM medication), 4/8/19 (4 PM medication), 4/20/19 (8 AM medications), 5/5/19 (8 AM medications), and 5/9/19 (noon medication). Resident #2's medication was administered more than one hour, after the facility's standard dosing schedule on: 5/5/19 (8 AM medications), and 5/13/19 (8 AM medications). Resident #3's medication was administered more than one hour, after the facility's standard dosing schedule on: 4/5/19 (8 AM medications), and 4/23/19 (8 AM medication). Resident #4's medication was administered more than one hour, after the facility's standard dosing schedule on: 4/23/19 (8 AM medications).
Plan of Correction:	The Healthcare coordinator or designee will in-service nursing staff on timely medication administration by 7/15/2019. The Healthcare coordinator or designee will review Accuflo dashboard daily at change of shift to monitor for any late medication administration. The Healthcare coordinator will review medication administration times and stagger them to reduce the caseload.