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Harmony at Independence
2077 South Independence Boulevard
Virginia beach, VA 23453
(757) 802-3665

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

Inspection Date: July 1, 2019 and July 2, 2019

Complaint Related: No

Areas Reviewed:
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
22VAC40-90 Background Checks for Assisted Living Facilities

Technical Assistance:
Please check the website often for updates and information.

Comments:
An unannounced renewal inspection was conducted on this date from 0n 7-1-19 (7:15a.m. until 3:30p.m) and on 7-2-19 (7:50a.m until 3:10p.m.) The Regional Licensing Administrator was on site a part of the second day of the inspection. Also Regional corporate staff were on site during all or part of the 2 day inspection. There were 55 residents in care. Eleven resident records and 5 staff records were reviewed. Three staff were observed administering medications . Interviews were conducted with families, staff, and residents. The last elevator inspection was 6-10-19. The water temperature measured ranged between 112.2 degrees and 112.8. degrees .The log of water temperature checks range from 105 degrees on the second floor to 114 degrees on the fourth floor. The facility has a generator that is every Monday The breakfast menu observed posted and served included oatmeal, eggs cooked to choice , bacon, potatoes, mixed fruit, juice, coffee, and Danish/muffins. During interview with the Director of Dining the inspector was told all new resident diet orders are received before the resident's admission. The Director also receives a list of likes and dislikes. Comment cards are available on the table.s The facility has a water delivery agreement . Over 90 gallons of water was on site. The posted morning excerise was observed on the first floor. Fourteen residents were participating. There was some discussion about talking with the direct care staff before delegating activities duties to them . Staff was advised to closely monitor the changes in the residents' ambulatory status to ensure they remain in compliance with the building's limited number of non ambulatory residents in the assisted living section. Also there was some discussion about staff communicating with residents prior to rendering any 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 7-18-19 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 measures

Violations:
Standard #: 22VAC40-73-450-F
Description: Based on record review , interview ,and observation the facility failed to ensure seven of eleven individualized service plans reviewed had been updated as the condition of the residents changes. The updates shall be performed by a qualified staff person and in conjunction with the resident and, as appropriate, with the resident's family, legal representative, direct care staff, case manager, health care providers, qualified mental health professionals, or other persons. Evidence 1. During a review of the residents' ISPs with staff # 1 and #3 , the inspector found the following : a. resident #4's ISP dated and signed 2-20-19, had not been updated to reflect the diet order dated 5-24-19 for a 2000 caloric diabetic diet /2000 sodium diet b. resident #8's ISP dated and signed 12 -20-18, had not been updated to include a plan of care for the rigid stiff contractors noted in the 5-2-19 nurse's note c. resident # 7's ISP dated and signed 3-1-19 ,had not been updated to include the mental services being provided d. resident #9's ISP dated,signed, and reviewed by phone with the legal representative on 5-24-19 , had not been updated to include the certification period for the PT and OT services e. resident #11's ISP dated and signed 4-4-19 , had not been updated to include a plan of care to monitor the resident's respiratory condition which had resulted in the resident being sent to the emergency room three times within the first three months of her 1-12-19 admission date. f. resident # 12's ISP did not include the walker the inspector observed in the resident's room g. resident # 13's ISP did not include the raise toilet seat the inspector observed in the resident's room 2. Staff #1 and #3 acknowledged the ISPs had not been updated to reflect the changes in the residents' condition.

Plan of Correction: Resident #4?s ISP was updated to reflect the diet order has been clarified and updated as per doctor?s orders. This was completed on day of inspection 7/14/19. Resident #8?s ISP was updated on 7/15/19 to include a plan of care for the resident?s rigidness. Resident #7?s ISP was updated to include mental health services on 7/14/19. Resident # 9?s ISP was updated on 7/15/19 to include the certification period for the PT and OT services. Resident #11?s ISP was updated on 7/14/19 to include a plan of care for the resident?s respiratory condition. Resident #12 does not have a walker. Therapy was using as a trial. ISP was updated to include the walker resident utilized as a trial and no longer has n 7/14/19. Resident # 13?s ISP was updated on 7/15/19 to include the raised toilet seat in the resident?s room. The above corrections to ISPs were updated by the HCC and/or designee. Moving forward there will be a weekly audit of 5 ISPs to ensure all necessary information has been transcribed onto the ISP. This will be completed by the ED and/or designee.

Standard #: 22VAC40-73-870-E
Description: Based on observation and interview the facility failed to ensure all furniture was in good repair and condition . Evidence 1. While on the secure unit with staff # 1 , the inspector observed three leather recliners with torn seats and worn arms in the common area. The multiple jagged splits in the leather seat cushion exposed the inner stuffing. 2. During the inspection residents were observed sitting and sleeping in the leather recliners . 3. Staff #2 acknowledged the chairs were not in good repair and condition.

Plan of Correction: The worn leather seats in Harmony Square were removed by the Maintenance Director and replaced with furniture in good condition on 7/11/19. Moving forward Maintenance and/or designee will check the furniture weekly upon cleaning for rips/tears or needed repair.

Disclaimer:
This information is provided by the Virginia Department of Social Services, which neither endorses any facility nor guarantees that the information is complete. It should not be used as the sole source in evaluating and/or selecting a facility.

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