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: July 19, 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

Comments:

An unannounced renewal inspection was conducted by two Licensing Inspectors from the Eastern Regional Office on 07-19-2019 from 8:03 AM to 12:39 PM. There were 46 residents in care at the time of the inspection. A tour of the facility was completed and breakfast was observed. 8 resident records and 4 staff records were reviewed in addition to criminal background checks and sworn disclosures for newly hired staff prior to the last renewal inspection. The facility conducted an exercise activity during the inspection. The facility's emergency preparedness plan and fire drills/first aid kits were reviewed. The Administrator was not present during the inspection. The following was discussed with the staff person in charge and facility consultant: required documentation for staff records, updates of posted menu's, documentation for the dietary oversight, time period reviewed during the health care oversight and recommendations made relating to residents reviewed, semi-annual resident emergency exercises, and UAI's and ISP's. The facility received violations under Administration and Administrative Services, Personnel, Resident Care and Related Services, Buildings and Grounds, and Emergency Preparedness. The areas of noncompliance were reviewed and discussed with the staff person in charge and the facility consultant throughout the inspection. 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 08-05-2019. 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. The provider's response for the "plan of correction" was not received as of 08-05-2019 and will not appear on this Violation Notice.

Violations:

Standard #:	22VAC40-73-100-C-1
Description:	Based on observation and interview, the facility failed to ensure procedures for the implementation of infection prevention measures by staff included use of standard precautions. Evidence: 1. During the medication pass observation at approximately 8:23 AM, staff #3 was observed dropping resident #2's white pill on top of the medication cart. Staff #3 was then observed picking the pill up with her bare hand and administered the medication to resident #2. 2. During interview, staff #2 and staff #3 acknowledged infection prevention measures were not implemented during the medication pass observation with resident #2.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-250-C
Description:	Based on record review and interview, the facility failed to ensure personal and social data was maintained in the staff?s record to include the position title and date employed, and documentation of orientation, training, and education required including any specified relevant information, with annual training requirements determined by starting date of employment Evidence: 1. During staff #3?s record review, staff #2 could not provide documentation of a date of employment, position title, orientation, or staff training for staff #3 during the inspection. 2. During interview, staff #2 confirmed the facility did not have the required documentation on file for staff #3.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-450-C
Description:	Based on record review and interview, the facility failed to ensure the individualized service plan (ISP) included a description of the resident?s identified needs. Evidence: 1. During resident #4?s record review with staff #1 and staff #2, the physician?s order dated 06-06-2019 documented ?Please assist patient to bathroom every 2 hours for timed voiding once a day, every day.? The current ISP dated 07-13-2019 did not include a description of the resident?s need to be assisted to the bathroom every 2 hours to void. In addition, the current Uniform Assessment Instrument (UAI) dated 07-12-2019 documented the resident needs mechanical assistance with stairclimbing; however stairclimbing was not identified on the ISP. 2. During resident #8?s record review with staff #1 and staff #2, the current UAI dated 10/04/2018 documented the resident needs physical assistance with bathing and mechanical assistance with transferring. The current ISP dated 10/02/2018 documented that staff would remind the resident to take a bath, however; the ISP did not include a description of how the staff will physically assist the resident with bathing. In addition, the resident?s need for transferring was not identified on the ISP. 3. During interview, staff #1 and staff #2 acknowledged resident #4 and resident #8?s ISP?s did not include a description of the residents' aforementioned identified needs.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-450-D
Description:	Based on record review and interview, the facility failed to ensure for private pay individuals, the uniform assessment instrument (UAI) was completed as required by 22VAC30-110. Evidence: 1. During resident #4's record review with staff #1 and staff #2, the current individualized service plan (ISP) dated 07-13-2019 documented the resident will use a shower stool and rails while bathing, and will need staff to assist with washing; however, the UAI dated 07-13-2019 was checked ?no? indicating the resident did not need assistance with bathing. In addition, the need for Eating/Feeding on the UAI was blank and was not checked ?yes? or ?no? to indicate if the resident needed assistance with eating. 2. During interview, staff #1 and staff #2 acknowledged resident #4's UAI was not completed as required.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-620-B
Description:	Based on record review and interview, the facility failed to ensure the oversight of special diets included a review of the physician's order and the preparation and delivery of the special diet, an evaluation of the adequacy of the resident's special diet and the resident's acceptance of the diet, identification of the residents for whom the oversight was provided, maintained in the files at the facility, with any specific recommendations regarding a particular resident also maintained in the resident's record, and upon receipt of recommendations noted in the administrator, dietitian, or nutritionist shall report them to the resident's physician. Evidence: 1. During resident record review, resident #1 had a physician?s order dated 04-03-2018 for a no concentrated sweets diet, and resident #8 had a physician?s order dated 05-31-2018 for a mechanical soft diet. 2. Staff #1 was asked to provide the most current dietary oversight for residents with special diets. Staff #1 provided a ?Nutrition Consult Report? dated 03-21-2019 which had a check mark beside initial and quarterly assessments, and a circle around consult referrals. The report also documented ?Follow up notes were provided on residents on modified diets and initial assessments were completed as needed.? In addition, the oversight did not include a list of residents for whom the oversight was provided. 3. During interview, staff #1 was asked to provide the list of the residents who were reviewed during the aforementioned dietary oversight; however, staff #1 was unable to provide this information. In addition, staff #1 was asked to provide the follow up notes and any recommendations that were made; however, staff #1 stated the facility did not have that information on file. Staff #1 acknowledged the facility did not have the required information on file for the dietary oversight.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-650-B
Description:	Based on record review, the facility failed to ensure the physician or other prescriber orders for administration or all prescription and over-the-counter medications and dietary supplements were included and had identified the diagnosis, condition, or specific indications for administering each drug. Evidence: 1. During resident #2?s record review, the current physician?s orders on file dated 07-11-2019 did not have a diagnosis, condition, or specific indications for the following medications: Aspirin 81 mg, Compression Stockings, Ferrous Sulfate 325 mg, Lantus 100 Unit/ml Sub-q, Mavyret 100 mg-40 mg, and Quetiapine 50 mg. 2. During interview, staff #2 confirmed the aforementioned diagnoses were missing on resident #2?s physician?s orders.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-680-D
Description:	Based on observation, record review, and interview, the facility failed to ensure medications were administered in accordance with the physician's instructions. Evidence: 1. During the medication pass observation at approximately 8:10 AM, staff #3 was observed administering an Advair 250-50 diskus inhaler to resident #1. Staff #3 did not rinse or inform resident #1 to rinse his mouth after the inhaler was administered. 2. During resident #1's record review with staff #1 and staff #2, the current physician?s orders dated 07-15-2019 documented ?Advair 250-50 Diskus? inhale 1 puff by mouth twice daily rinse mouth after use.? 3. During interview at approximately 12:10 PM, resident #1 stated he did not rinse his mouth after the Advair inhaler was administered and was not instructed by staff #3 to rinse his mouth. 4. During the medication pass observation at approximately 8:23 AM, staff #3 was observed administering 1 tab of Glimepride 4mg to resident #2. Staff #3 did not administer the medication with food. 5. During resident #2?s record review, the current physician?s orders dated 07-11-2019 documented ?Glimepride 4mg tablet- 1 tab orally in AM and ? tab orally in pm. With meals for Diabetes.? 6. At approximately 8:52 AM, resident #2 was observed sitting in the dining room waiting for breakfast to be served. At 9:02 AM resident #2 was observed eating breakfast. 7. During interview, staff #1, staff #2, and staff #3, acknowledged resident #1 and resident #2?s aforementioned medications were not administered in accordance with the physician?s instructions. In addition, staff #2 provided an order dated 07-19-2019 at the time of the inspection, which documented the Glimepride could be administered 30 minutes prior to a meal; however, per staff #2 the order was obtained after the medication pass observation was completed.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-860-G
Description:	Based on observation, the facility failed to ensure that hot water taps available to residents were maintained within a range of 105?F to 120?F. Evidence: 1. During the tour of the facility with staff #2, the following hot water temperatures were sampled from the bathroom sinks: a. In both of the men?s restrooms, the hot water temperatures read 130.8?F and 136.4?F. b. In both of the women?s restrooms, the hot water temperatures read 135?F and 132.1?F. 2. During interview, staff #2 acknowledged the aforementioned water temperatures were not within the required range of 105?F to 120?F.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-870-A
Description:	Based on observation, the facility failed to ensure the interior of the building was maintained in good repair. Evidence: 1. During the tour of the facility with staff #2, the following areas observed were not maintained in good repair : a. A 12x12? floor tile in the front left hallway outside of the women?s restroom had a strip (approximately 4? in length) of the time that was missing. In addition, a portion of another 12x12? floor tile was cracked in the top right corner. b. A 12x12? floor tile in the front right hallway outside of the men?s restroom had a section (approximately 2x2?) of the tile that was missing. c. A strip of the paint (approximately 12? in length) was chipped on the wall located in the men?s restroom (Room #1). 2. During interview, staff #2 acknowledged the aforementioned areas were not maintained in good repair.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-870-E
Description:	Based on observation and interview, the facility failed to ensure all furnishings, fixtures, and equipment, including sinks, bathtubs, and showers were kept clean and in good repair and condition. Evidence: 1. During the tour of the facility with staff #2, the following areas observed were not maintained in good repair : a. A black substance was observed on the floor of the bathtub in the women?s restroom (Room #3). b. A white and black substance was observed on the floor and the sides of both of the bathtubs in the men?s restrooms (Room #1 and Room #2). c. The sink was clogged while testing the hot water temperature in the men?s restroom in the front right hallway. d. A 2x2? square tile was missing on the shower floor of the women?s restroom (Room #4). 2. During interview, staff #2 acknowledged the aforementioned areas were not maintained in good repair.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-990-C
Description:	Based on record review and interview, the facility failed to ensure at least once every six months, all staff currently on duty on each shift should participate in an exercise in which the procedures for resident emergencies are practiced. Documentation of each exercise should be maintained in the facility for at least two years. Evidence: 1. Staff #1 and staff #2 provided a copy of the facility?s resident emergency exercise which documented ?Resident went outside fire in building in the med room. Went over with resident case study on mental illness and if someone is attacking or bullying. Tornado in building, resident demonstrated on what to do.? The resident emergency exercise did not include a description of the facility?s procedures that were practiced. In addition, the resident emergency exercise was not dated. 2. During interview, staff #1 and staff #2 were unable to provide additional documentation regarding the procedures that were practiced during the resident emergency exercise. Staff #1 and staff #2 acknowledged that the facility did not have documentation of the procedures that were followed during the exercise.
Plan of Correction:	Not available online. Contact Inspector for more information.