VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Open Arms Adult Home II, LLC
1229 27th Street
Newport news, VA 23607
(757) 285-7829

Current Inspector: Willie Barnes (757) 439-6815

Inspection Date: July 15, 2019

Complaint Related: No

Areas Reviewed:

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 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

Comments:

An unannounced renewal inspection was conducted on 7-15-19 (ar 07:35am/dep 4:15pm). The facility census was 10. The administrator was present for the entrance interview. A medication pass observation, tour of facility, staff and resident records reviewed, staff and resident interviews, meal and activity was not able to be observed. The facility's emergency food supply was not observed due to staff not having the key to access the food storage area. The exit interview was conducted with the assistant administrator. The acknowledgement form was also signed by the assistant administrator who was also present during review of staff and resident record reviews. Please complete the columns for "description of action to be taken" and "date to be corrected" for each violation cited on the violation notice, and then return a signed and dated copy to the licensing office within 10 calendar days of receipt. You need to be specific with how the deficiencies either have been or will be corrected to bring you into compliance with the Standards. Your plan of correction must contain the following three points: 1. Steps to correct the noncompliance with the standard(s) 2. Measures to prevent the noncompliance from occurring again 3. Person(s) responsible for implementing each step and/or monitoring any preventive measure(s) Please provide your responses in a Word Document, if possible. POC due within 10 days.

Violations:

Standard #:	22VAC40-73-250-C
Description:	Based on record review, document review and staff interview, the facility failed to ensure the personal and social data maintained on staff did not include all required documents. Evidence: 1. On 7-15-19 during a review of the sample staff records with staff #2, the date of hire for staff #3 was documented as 12-31-18. Further review of staff #3's record, the job description for direct care/ medication aide/ manager was signed by staff #3 on 12-31-18. A review of staff #3's application did not include previous employment. 2. A copy of staff #3's direct care training document noted the last date of training was 3-12-19. The facility's staff schedule provided to the inspector on 7-22-19 noted staff #3 on the facility's staffing schedule on 12-26-18. 3. Staff #2 acknowledge the staff's training date and documentation of knowledge and skills for direct care was prior to the staff's date of hire as a direct care person.
Plan of Correction:	Documentation has been received prior to staff date of hire & signing of job description.
Standard #:	22VAC40-73-490-A-2
Description:	(490-A.1.a) Based on document review and staff interview, the facility failed to ensure the health care oversight was conducted at least every six months for residents in the assisted living facility. Evidence: 1. On 7-15-19 during a review of the health care oversight document with staff #2, the date of the last review was documented for the period "6/1/18---11/30/18 and conducted on 12/20/2018". 2. Staff #2 acknowledge the document presented to the inspector was the most recent report of the facility's health care oversight.
Plan of Correction:	Administrator will ensure health care oversight is conducted after the 6 months 1st half or end half of the year has been completed.
Standard #:	22VAC40-73-680-C
Description:	Based on record review, document review and staff interview, the facility failed to ensure medications shall be administered not later than one hours after the facility's standard dosing schedule, except those drugs that are ordered for specific times, such as before, after, or with meals. Evidence: 1. On 7-15-19 during the medication pass observation with staff #1, the facility dosing schedule is documented on the residents' medication administration record (mar) as 8:00 am. At 8:29 am, following administration of resident #4's medication, staff #1 was still administering medications to residents. When asked, staff # 1 stated having four residents remaining who had not received medications. 2. Staff #1 acknowledge having 4 residents who not received medications following the inspector informing staff of the time (08:29)
Plan of Correction:	Medication aide will begin medication administration one hour prior to medication time or change medication administration time.
Standard #:	22VAC40-73-870-A
Description:	Based on observation and staff interview, the facility failed to ensure the building was maintained in good repair and kept clean. Evidence: 1. On 7-15-19 upon entry to the facility with staff #1, the common area on the first floor area near the resident's lockers, water was observed leaking from the ceiling. Water was also observed dripping from the gutter on the first level of the roof located on the driveway side of the facility. 2. During the tour with staff #1, the flooring on the back porch was loose near the entrance to the facility. The back door is missing a screened door; the area near the base of door is rotted and in need of repair. 3. The male bathroom upstairs was observed with the floor in need of cleaning, the sink was coming apart from the wall near the faucet area. The toilet base was observed to be loose and need of repair and the toilet seat is also in need of repair. 4. Staff #1 acknowledge during the tour the areas mentioned were in need of repair.
Plan of Correction:	Plumber will be called to examine water leakage & repair to ensure no fall risk, injuries & bldg remain in a safe living status (07/15/19) Maintenance will examine back port flooring & repair boards and brace to ensure door will be replaced & screen door will be installed to prevent unwanted pest. (08/09/19) Sink in bathroom will be caulked & tighten toilet base will be secured to floor & toilet seat replaced. (07/5/19)
Standard #:	22VAC40-73-870-D
Description:	Based on observation and staff interview, the facility failed to ensure the building and grounds shall be kept free of insects and vermin and free of their breeding places. Evidence: 1. On 7-15-19 during a tour of the facility and the grounds with staff #1, dead flies were observed in the window sill of the window located across from the kitchen door. 2. On 7-15-19 during a tour of the outside/grounds area with staff #1, the backyard and side of the yard on the driveway was observed with empty crates, washing machines, large metal traps, cans and bottles in various areas on the ground. An open container of trash was observed with flies swarming next to a washing machine. The fence in the backyard was observed with multiple board items laying against the fence. 3. Staff #1 acknowledge the areas toured in and outside the facility of facility were in need of trash and large items to be disposed.
Plan of Correction:	Pest policy will be reviewed with housekeeping to ensure proper pest control is used to ensure window will is free from dead flies to prevent disease. (07/15/19) Maintenance will ensure bldg & grounds are kept free of appliances, can, bottles, creates, traps & other unwanted items. Trash will be properly disposed with a lid to prevent pest. (07/16/19)