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: July 18, 2019 , July 19, 2019 and July 24, 2019

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 STAFFING AND SUPERVISION 22VAC40-73 RESIDENT CARE AND RELATED SERVICES

Comments:

Complaint inspections were conducted on 7/18/19, 7/19/19, and 7/24/2019 in response to complaints received by the licensing office on 7/9/19 and 7/18/19, regarding Staffing & Supervision and Resident Care and Related Services. Facility documents were reviewed and resident records were observed. Violations were 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 #:	22VAC40-73-290-A
Complaint related:	Yes
Description:	Based on documentation and interview, the facility failed to maintain a written work schedule that includes the names and job classifications of all staff working each shift, with an indication of whomever is in charge at any given time. Any absences, substitutions, or other changes shall be noted on the schedule. Evidence: The facility's schedule (July) and employee time sheets were reviewed, during the inspection. Staff #1 was listed as working on 7/7/19, during the 3 PM - 11 PM shift. The shift did not appear on Staff #1's time sheet. Facility staff reported that Staff #1 did not work on 7/7/19 and that another staff member worked the shift instead. No staffing changes were noted on the schedule. Staff #2 is listed on the work schedule on 7/16/19 (11PM - 7 AM shift). The shift did not appear on Staff #2's time sheet. Facility staff reported that Staff #2 did not work on 7/16/19, as she was on leave. No staffing changes were noted on the schedule. The facility's schedule has an area to list the designated person in charge, when the Administrator and HCC are out of the community. This area was blank for 14 out of the 15 days that were reviewed.
Plan of Correction:	The Executive Director will re-educate the HCC/Harmony Square Coordinator by 8/30/2019 to maintain a written work schedule that includes the names and job classifications of all staff working each shift, with an indication of whomever is in charge at any given time. Any absences, substitutions, or other changes will be noted on the schedule and that the posted schedule will reflect and mirror the daily assignment sheets. The HCC will also ensure that the posted schedule lists the designated person in charge when the Healthcare coordinator and Administrator are out of the community. The Healthcare coordinator and Harmony Square Coordinator will also check ADP daily for any login discrepancies on an ongoing basis.
Standard #:	22VAC40-73-680-D
Complaint related:	Yes
Description:	Based on record review, the facility failed to ensure that medications are administered in accordance with the physician's instructions and consistent with the standards of practice outlined in the current registered medication aide curriculum approved by the Virginia Board of Nursing. Evidence: The medication administration records (MAR) for several residents were observed during the inspection. Resident #1 receives Humulin three times per day. Resident #1's Humilin is administered, based upon his blood surgar reading. On 7/3/19 (11 AM administration), Resident #1's blood sugar was recorded as 238 and he received four units of Humulin. The physician's order, dated 6/20/19, states that the resident should receive two units of Humulin when the resident's blood sugar is between 200 and 250. The physician's order states that the resident should receive four units of Humulin when the resident's blood sugar is between 251 and 300. The medication administration record (MAR) for Resident #2 was observed during the inspection. On 7/10/19, Resident #2's MAR indicates that she did not receive Olanzapine 2.5, as the medication was listed as "not available."
Plan of Correction:	The Healthcare coordinator will in-service all nurses and Medtechs by 8/30/2019 to ensure that all Medications are administered in accordance with the physician's or other prescriber's instructions and consistent with the standards of practice outlined in the current registered medication aide curriculum approved by the Virginia Board of Nursing. In-service was conducted by the Healthcare coordinator (HCC) on 8/5/2019 regarding correct insulin administration and medication availability. The HCC will audit medication carts to ensure availability of medications by 8/30/19.