VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Commonwealth Senior Living at Stratford House
1111 Main Street
Danville, VA 24541
(434) 799-2266

Current Inspector: Jennifer Stokes (540) 589-5216

Inspection Date: July 23, 2019

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 RESIDENT CARE AND RELATED SERVICES

Comments:

On 7/23/2019 one inspector conducted a complaint investigation (11:10am to 3:45pm) involving allegations of insufficient staffing, not having medications for residents, giving medications late, staff doesn't answer call bells, and not providing a required service. One resident record and numerous other documents were reviewed. The call bell system was tested and the response came in approximately three minutes. There is no evidence to support the allegation of insufficient staffing or that a required service is not being given. There is documentation to support that medications have been given late and that medications have not been available to administer to residents. This complaint is valid.

Violations:

Standard #:	22VAC40-73-680-C
Complaint related:	No
Description:	Based on document review, the facility failed to administer medications no earlier than one hour before and not later than one hour after the facility's standard dosing schedule. EVIDENCE: 1. The Med Variance record shows that on 6/17/2019 the medications listed below were given outside the window of one hour before or one hour after the scheduled dosing time for resident 1. The schedule dosing time for these is 8am, and the following medications were given at 9:21am: aspirin chew 81mg, atenolol 50mg, chlorthalidone 25mg, clopidogrel 75mg, ferrous gluc 240mg, fluoxetine 20mg, hydralazine 20mg, isosorb mono ER 30mg, l-arginine 1000mg, Linzess 72mcg, losartan 25mg, magnesium citrate 400mg, metformin 500mg, ondansetron 4mg, polyethylene gly pwd 510gm, ranolazine ER 1000mg, and red yeast rice 600mg.
Plan of Correction:	Resident Care Director or designee will review medication administration times and MARs to ensure that enough time is permitted to administer medications not earlier than one hour before and one hour after the facility?s standard dosing schedule. Resident Care Director will re-educate all RMAs and Nurses on adherence to the Rights of Medication Administration. Resident Care Director or designee will conduct a random medication pass audit a minimum of 2 times per month to ensure ongoing compliance and provide any necessary coaching on medication administration concerns.
Standard #:	22VAC40-73-680-D
Complaint related:	No
Description:	Based on document review, the facility failed to administer a medication in accordance with prescriber's instructions. EVIDENCE: 1. The record for resident 1 shows a prescription for Keflex 500mg one tablet three times a day for seven days, dated 6-4-2019. The medication administration record (MAR) shows that this antibiotic was not administered until 8:30am on 6/7/2019. 2. The MAR for resident 1 shows that an order was written on 6/27/2019 for torsemide 20mg and it was not given as scheduled on 6/28/2019 at 9:30am because the medication was not available.
Plan of Correction:	All nurses and RMAs to be re-inserviced on the importance of medications being administered in accordance with the physician orders and Board of Nursing Standard of Practice as well as alerting the pharmacy immediately should the medication not be delivered on the scheduled delivery to request a STAT delivery. The Resident Care Director, or designee, to ensure that medication is delivered timely for administration and will randomly audit the medication documentation records of a minimum of 5 residents per month to ensure continued compliance.
Standard #:	22VAC40-73-680-I
Complaint related:	No
Description:	Based on document review, the facility failed to correctly document medication administration records (MAR). EVIDENCE: 1. The Narrative Charting notes for resident 1 show that she went to the hospital on 6/28/2019 sometime between 9:30pm and 10:30pm. The resident never returned to the facility. The MAR for July 2019 shows that staff 1 administered the 8am doses on 7/1 and 7/2/2019 of the following to resident 1, when she was out of the building in the hospital: atenolol 50mg, chlorthalidone 25mg, citalopram 10mg, clopidogrel 75mg, ferrous gluc 240mg, fluoxitine 20mg, furosemide 40mg, hydralazine 50mg, isosorb mono ER 30mg, l-arginine 1000mg, Linzess 72mcg, losartan 25mg, magnesium citrate 100mg, ondansetron 4mg, polyethylene gly pwd 510mg, ranolazine ER 1000mg, red yeast rice 300mg, spironolactone 25mg, torsemide 20mg, and vitamin B-12 1000mg. The MAR also shows that on 7/1/2019, when resident 1 was at the hospital, staff 1 administered nitrofuranoin macro 100mg to resident 1.
Plan of Correction:	All nurses and RMAs were re-educated on documentation. Executive Director, Resident Care Director, and/or designee will ensure that associates are educated on medication administration documentation at time of hire, annually, and as needed. Executive Director, Resident Care Director, and/or designee will conduct a med pass audit to include a review of documentation a minimum of 1 time per month to ensure ongoing compliance.