VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Ginter Hall South
11300 Mall Court
N. chesterfield, VA 23235
(804) 794-7770

Current Inspector: Yvonne Randolph (804) 662-7454

Inspection Date: Sept. 26, 2019

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-73 BUILDING AND GROUNDS

Technical Assistance:

Restraints

Comments:

An unannounced inspection was conducted at the facility on 9/26/2019 to investigate an allegation regarding a resident's fall. Based on a review of the resident's file, incident reports, interviews with staff and a family member of the resident, the allegation was determined to be valid. See violation notice for non-compliance. Please complete the "plan of correction" and "date to be corrected" for the violation cited on the violation notice and return to the Inspector within 10 days. You will need to specify how the deficient practice will be or has been corrected. Just writing the word "corrected" is not acceptable. Your plan of correction must contain: 1) steps to correct the non-compliance with the standard, 2) measures to prevent the noncompliance from occurring again; and 3) person(s) responsible for implementing each step and/or monitoring any preventive measure(s).

Violations:

Standard #:	22VAC40-73-460-D
Complaint related:	Yes
Description:	Based on an inspection at the facility, a review of one resident's file, interviews with staff and family of the resident, the facility failed to provide supervision of one resident's care, specifically the prevention of falls. Evidence: Licensing staff received a call from the family of resident A, reporting that the resident had fallen during incontinence care. A review of the resident's file found that the resident's movement is restricted by body contracture. The resident's uniform assessment instrument (UAI) dated 8/19/19 documents that the resident is dependent in toileting and transferring and requires mechanical/human help. Based on a review of incident reports and an interview with the facility's administrator, it was determined that the resident was placed too close to the edge of the bed by staff during the incontinence care causing the resident to fall.
Plan of Correction:	Mats are placed appropriately on each side of bed. The physician wrote an order for side rails to be used for turning/repositioning and changes for incontinence care every two hours and as needed, side rails are in place. Two nursing staff will provide assistance for safety during all changes. Care plan has been updated and guardian notified.