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Cary Adult Home
7336 Cary Avenue
Gloucester, VA 23061
(804) 693-7035

Current Inspector: Willie Barnes (757) 439-6815

Inspection Date: July 9, 2019

Complaint Related: Yes

Areas Reviewed:
22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES
22VAC40-73 ADMISSION, RETENTION, AND DISCHARGE OF RESIDENTS
22VAC40-73 RESIDENT CARE AND RELATED SERVICES
22VAC40-73 EMERGENCY PREPAREDNESS

Comments:
An unannounced complaint inspection was conducted by two Licensing Inspectors from the Eastern Regional Office. The inspection was conducted on July 9, 2019 from 10:32 AM until 3:15 PM. There were 52 residents in care. The complaint alleged concerns regarding resident weight loss due to the facility's food/nutrition, emergency procedures, incident reporting, and resident medical care. During the inspection a tour of the building was conducted, to include a review of the facility's food supply. The facility's written plan for resident emergencies was reviewed. A lunch meal was observed as posted on the menu consisting of BBQ on a bun, coleslaw, carrots and tea. Residents were given a choice of a second serving. Dietician's reports were reviewed, as well as menus and monthly resident weight logs. Resident records were also reviewed. The following was discussed with the Administrator during the inspection: Ensuring weekly menus indicate the specific items being served, Ensure scale is calibrated/accurate for monthly weights, Information to be included on the Individualized Service Plan (ISP). Based on the information gathered during this inspection, the complaint was found to be valid. The areas of non-compliance were reviewed with the Administrator throughout the inspection and during the exit interview. Please complete the 'plan of correction' and 'date to be corrected by' for each violation cited on the violation notice. The plan of correction must indicate how the violation will be or has been corrected. Just writing the word 'corrected' is not acceptable. Your plan of correction should include: 1. Step(s) to correct the non-compliance 2. Methods to prevent reoccurrence 3. Person(s) responsible for implementing each step and/or monitoring any preventive action. If you have any questions, please contact your inspector at 757-353-0430.

Violations:
Standard #: 22VAC40-73-70-A
Complaint related: Yes
Description: Based on record review and interview, the facility failed to report to the regional licensing office within 24 hours any major incident that has negatively affected or that threatened the life, health, safety, or welfare of any resident. Evidence: 1. During review of resident #1's record, the nursing notes in the record dated 06-07-19 indicated the resident had a fall in the dining room. The report indicated that the resident had a "gash on his nose, bit his top and bottom lip, and had a red mark/bump on his forehead". The resident was sent out to the hospital. Hospital discharge notes indicated the resident had a nose fracture. 2. During interview, staff #1 acknowledged resident #1 was sent out to the hospital on 06-07-19 due to a fall which caused a nose fracture. Staff #1 acknowledged that an incident report was not sent to the regional licensing office.

Plan of Correction: Administrator will insure appropriate state agencies to include Social Services and DSS will be notified in the even of any incident.

Standard #: 22VAC40-73-310-L
Complaint related: No
Description: Based on record review and interview, the facility failed to ensure that when care for a resident?s special medical needs is provided by licensed staff of a home care agency, the assisted living direct care staff receive training from the home care agency staff in appropriate treatment monitoring techniques and it shall be documented and maintained in the staff record. Evidence: 1. During review of resident #3's record, the record contained a home health care progress note dated 07-03-19 that documented ?Patient has wound to L lower leg. Previously treated with antibiotics but unable to heal properly. PT has DM [diabetes mellitus].? 2. Resident #3's ?Assessment and Plan? on the home health care progress note documented resident is to have dressing changed twice daily with sterile dressing, receive cream to the wound, receive two antibiotics, and receive dietary assistance to regulate diet. 3. During interview, staff #1 stated that direct care staff is providing dressing changes to resident?s wound, but was unable to provide documentation that facility staff received wound care training to provide dressing changes to resident #3's wound.

Plan of Correction: Administrator will insure any resident that needs special treatments like wound care will receive Home Health Care (HHC). If HHC provides any training for dressing changes etc. documentation will be maintained in file.

Standard #: 22VAC40-73-470-A
Complaint related: Yes
Description: Based on record review and interview, the facility failed to ensure, either directly or indirectly, that the health care service needs of residents were met, to include: when a resident is unable to participate in making appropriate arrangements, the resident's legal representative shall be notified of the need. Evidence: 1. During review of resident #1's record, facility nursing notes indicated resident #1 had a fall on 06-07-19 and was sent out to the hospital. Per the hospital discharge notes also dated 06-07-19, the resident had a nose fracture. The hospital discharge note instructed the resident to follow-up with an Otolaryngologist (Ear, Nose, & Throat specialist) in two (2) days. Further review of resident #1's record revealed the resident has a court appointed Guardian since 2016, indicating the resident is unable to make appropriate decisions regarding his care needs. 2. During interview, staff #1 indicated the facility did not make a follow-up appointment with the Ear, Nose, & Throat (ENT)specialist because resident #1 stated he did not need to go. Staff #1 indicated that the Guardian was not notified of the hospital discharge instructions until 06-26-19 when the Guardian conducted a visit to the facility. As of the date of the inspection on 07-09-19 the resident had not attended an ENT visit.

Plan of Correction: Administrator did notify guardian and left 2 messages took 2 weeks for guardian to return call. Since incident have been given emergency number for guardian organization. Administrator will notify clients legal rep/guardian to insure resident's appropriate needs are met and any follow up appts are scheduled.

Standard #: 22VAC40-73-570-D
Complaint related: Yes
Description: Based on record review and interview, the facility failed to provide information necessary to the care of a resident to the hospital or emergency medical personnel. Evidence: 1. The facility's policy for Resident Emergencies indicates that the facility will "Provide Patient Transfer form to appropriate rescue personnel". 2. Review of resident #1's record revealed the resident had a fall on 06-07-19 which required the resident to go to the hospital. In addition licensing inspector found the resident has a Guardian effective 2016 as per the court order observed in the record. 3. During interview, staff #1 indicated that on 06-07-19 resident #1 did not want to go to the emergency room by ambulance, therefore staff #2 transported the resident to the emergency room. According to staff #1, facility staff does not stay with the resident if the resident is "able to speak for themselves". Staff #1 stated resident was given the Patient Transfer form and a copy of his identification card and social security card. 4. Review of resident #1's Patient Transfer Form provided to the hospital revealed the form did not include all information necessary to care for the resident, to include: a. The resident's need for a Guardian to make decisions regarding his medical care. The form listed the agency name and as the "next of kin", however did not identify the agency as the Guardian. b. The resident's diagnosis and medical conditions. The form indicated the resident "has a physical handicap due to car accident", however it does not indicate the resident's diagnosis.

Plan of Correction: Administrator will make sure any resident that goes to hospital has the proper paperwork with updated name, address and phone numbers of family and/or guardian.

Standard #: 22VAC40-73-680-E
Complaint related: No
Description: Based on record review, the facility failed to ensure that medical procedures or treatments ordered by a physician or other prescriber shall be provided according to his instructions and documented. Evidence: 1. Resident #3 had a physician's order dated 07-03-19 for Bactroban cream two times per day for 10 days; however, resident?s July 2019 Medication Administration Record (MAR) did not include the Bactroban cream. Resident #3's record contained a physician's order also dated 07-03-19 for daily dressing changes two times per day due to a lower leg wound. There was no documentation in the record to confirm the resident's dressing was being changed. 2. Staff #1 acknowledged the resident's Bactroban cream was on site which was observed by Licensing Inspectors (LIs) on 07-09-19, but was not able to provide documentation to show the facility has been administering the cream to the resident and to show the daily dressing changes as instructed.

Plan of Correction: Administrator will insure any new medications will be on the MAR. Bi-weekly audits will be implemented.

Standard #: 22VAC40-73-990-A
Complaint related: No
Description: Based on record review and interview, the facility failed to ensure the written plan for handling medical emergencies, identifies the staff person responsible for (i) calling the rescue squad, ambulance service, resident's physician, or Poison Control Center; and (ii) providing first aid and CPR, when indicated. Evidence: 1. Review of the facility's written plan for resident emergencies revealed the procedures do not identify the staff person responsible for (i) calling the rescue squad, ambulance service, resident's physician, or Poison Control Center; and (ii) providing first aid and CPR, when indicated. The facility's written plan indicates the procedures to be followed and lists seven (7) steps, but not the staff person who is responsible. 2. During interview, staff #1 acknowledged the written plan for resident emergencies provided to licensing inspector was the facility's plan which did not identify the staff person responsible for the tasks mentioned.

Plan of Correction: Administrator will make sure any resident that goes to hospital has the proper paperwork with updated information such as name, address, and phone numbers of family and/or guardian. Every shift will have a designated staff person in charge and listed on schedule.

Disclaimer:
A compliance history is in no way a rating for a facility++.

The online compliance history includes only information after July 1, 2003. In addition, the online compliance history includes information regarding adverse actions that may be the subject of a pending appeal. An adverse action is not final until a provider has exhausted or waived all due process rights. For compliance history prior to July 1, 2003, or information regarding the status of pending adverse actions, please contact the Licensing Inspector listed in the facility's information. The Virginia Department of Social Services (VDSS) is not responsible for any errors in or omissions from the compliance history information.

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