VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Babcock Manor, Inc.
State Route 691
Appomattox, VA 24522
(434) 352-8686

Current Inspector: Cynthia Jo Ball (540) 309-2968

Inspection Date: Aug. 14, 2019

Complaint Related: No

Areas Reviewed:

22VAC40-73 GENERAL PROVISIONS 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 32.1 Reported by persons other than physicians 63.2 General Provisions. 63.2 Protection of adults and reporting. 63.2 Licensure and Registration Procedures 63.2 Facilities and Programs.. 22VAC40-90 Background Checks for Assisted Living Facilities 22VAC40-90 The Sworn Statement or Affirmation 22VAC40-90 The Criminal History Record Report 22VAC40-80 THE LICENSE. 22VAC40-80 THE LICENSING PROCESS. 22VAC40-80 SANCTIONS.

Comments:

The LI for Babcock Manor conducted an unannounced renewal study at the facility on 8/14/19 from 9am until 2pm and noted 30 residents to be in care. Resident and staff records as well as other forms of facility documentation were reviewed. A tour of the facility physical plant was conducted and interviews were held with resident sand staff. The mid day medication pass and mid day meal was observed. If you have any questions please feel free to contact your LI at 540-309-2968.

Violations:

Standard #:	22VAC40-73-1040-A
Description:	Based on physical plant observations, the facility failed to ensure that system of security monitoring for residents with serious cognitive impairments was on all doors leading to the outside. EVIDENCE: 1. The door leading to the outside in the hallway next to room 9 had an inoperable alarm system at the time of inspection.
Plan of Correction:	The administrator will ensure that all alarm systems are functioning properly. Staff trained to make sure they know how to work alarms. Daily rounds will be made to test door alarms.
Standard #:	22VAC40-73-250-C
Description:	Based on staff record reviews, the facility to maintain all required information in staff records. EVIDECNE: 1. The record for staff person 1, hired on 7/28/19, does not include the employees position or title or any qualifications for the position that they are in.
Plan of Correction:	The administrator will place the required information in staff person 1's record and will be sure to include all pertinent information is in all staff records.
Standard #:	22VAC40-73-250-D
Description:	Based on staff record reviews, the facility failed to maintain all required health information. EVIDENCE: 1. The record for staff person 1, hired on 7/28/19, does not have documentation that a screening for tuberculosis was completed on or within seven days prior to the first day of work at the facility. 2. The record for staff person 3 has documentation that the last annual screening for tuberculosis was completed on 6/13/18.
Plan of Correction:	The administrator will ensure that all employees receive screenings for tuberculosis as required and that all documentation is kept in staff records.
Standard #:	22VAC40-73-310-B
Description:	Based on resident record reviews, the facility failed to ensure that an interview with the residnet was documented prior to admission. EVIDENCE: 1. The record for resident 3, admitted on 4/26/19, did not contain documentation of an interview that occurred with the resident prior to their admission.
Plan of Correction:	The administrator will ensure that the documented interview is completed prior to admission and placed in all resident records.
Standard #:	22VAC40-73-310-D
Description:	Based on resident record reviews, the facility failed to maintain a copy of the written assurance provided to a resident in the residents record. EVIDENCE: 1. The record for resident 3, admitted on 4/26/19, did not contain a copy of the written assurance that was provided to the resident prior to their admission.
Plan of Correction:	Upon completion of interview a written assurance will be given to residents prior to admission.
Standard #:	22VAC40-73-350-B
Description:	Based on resident record reviews, the facility failed to ascertain, prior to admission, whether a potential resident is a registered sex offender EVIDENCE: 1. The record for resident 3, admitted on 4/26/19, did not contain a copy of a sex offender screening that was completed prior to the residents admission.
Plan of Correction:	Sex offender screening has been completed and will be completed prior to admission for all new residents.
Standard #:	22VAC40-73-390-C
Description:	Based on a review of resident records, the facility failed to update resident agreements when changes in policies and other information occurred. Evidence: 1. The records for residents 1 through 7 were all noted to contain an incomplete resident agreement, which did not include information required by the new regulations that were effective 2/1/2018.
Plan of Correction:	All residents will receive a new resident agreement forms.
Standard #:	22VAC40-73-440-A
Description:	Based on resident record reviews, the facility failed to ensure that uniform assessment instruments (UAIs) were completed as required. EVIDENCE: 1. The private pay UAI dated 7/22/19 in the record for resident 1 has that the resident requires no assistance with transferring, walking, stair climbing or mobility and is continent of bladder. An interview with staff person 3 expressed that resident 1 requires mechanical assistance of a walker for transferring, walking and mobility and is incontinent of bladder and requires the use of pull ups. 2. The UAI dated 4/2/19 in the record for resident 2 has documentation of human help only and mechanical and human help for bathing. The UAI also has documentation that professional nursing staff administer medications but the facility has registered medication aides which are considered laypersons. The UAI does not have any documentation for resident 2's orientation lavel but does have a noted that the resident has short term memory.
Plan of Correction:	The administrator will ensure that all UAI's are updated to reflect current ADL needs.
Standard #:	22VAC40-73-450-C
Description:	Based on resident record reviews, the facility failed to ensure that identified needs were addressed on individualized service plans (ISPs). EVIDENCE: 1. The record for resident 1 has a physician order dated 3/1/19 for a regular diet. The comprehensive ISP dated 4/1/19 is inconsistent as it has documentation that the resident is on a no concentrated sweet diet. An interview with staff person 3 expressed that resident 1 is incontinent of bladder and wears pull ups. The ISP does not address this identified need.
Plan of Correction:	The administrator/designee will review all ISP's and update with residents assessed needs.
Standard #:	22VAC40-73-450-D
Description:	Based on a review of resident records, the facility failed to ensure that all coordinated services provided by hospice and by the facility were included on the residents individualized service plans (ISPs). EVIDENCE: 1. The ISP dated 4/1/19 in the record for resident 1 does not include all coordinated services agreed upon between the hospice provider and the facility. 2. The ISP dated 4/9/19 in the record for resident 5 does not include all coordinated services agreed upon between the hospice provider and the facility.
Plan of Correction:	The administrator/designee will update resident ISP's to include all hospice services.
Standard #:	22VAC40-73-550-F
Description:	Based on physical plant observations, the facility failed to ensure that resident rights and responsibilities were posted in the facility. EVIDENCE: 1. The facility did not have a posting of resident rights at the time of the inspection.
Plan of Correction:	Resident rights were posted on the day of inspection.
Standard #:	22VAC40-73-550-G
Description:	Based on resident record reviews, the facility failed to ensure that an annual review of resident rights and responsibilities was completed with residents. EVIDENCE: 1, The records for residents 1, 2 and 4 has documentation that the last annual review of resident rights was completed on 87/1/2018.
Plan of Correction:	The administrator/designee will ensure that a review of resident rights is completed annually with all residents.