VIRGINIA DEPARTMENT OF SOCIAL SERVICES

The Haven Assisted Living @ Sandy Valley
4350 Sandy Valley Road
Mechanicsville, VA 23111
(804) 779-3154

Current Inspector: Shelby Haskins (804) 305-4876

Inspection Date: Oct. 9, 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

Comments:

On 09/26/2019 and 09/27/2019 the inspector was on site to conduct the renewal inspection. Based on the census offered four residents, three staffs and other facility records were reviewed for compliance. On both days of the renewal inspection the residents were observed at their leisure. Upon the arrival of the inspector on 09/27/2019 the facility?s registered medication aide was not on site. The inspector reviewed the facility?s medication noncompliance with a facility Manager that arrived at the facility later. All required postings were visible. Due to the facility?s inability to make copies of requested documentation the facility agreed to fax the identified documents to the department. There were no obvious physical plant concerns. The noncompliance revealed during this renewal inspection is contained within this report. Please complete the "plan of correction" and "date to be corrected" for each violation cited on the violation notice and return to the Inspector within 10 calendar days from today. 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(s), 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). Please contact me at (804) 662-9774 or by e-mail at Angela.r.reaves@dss.virginia.gov., if you have any questions.

Violations:

Standard #:	22VAC40-73-680-D
Description:	Based on the review of the facility?s records with a facility Manager on 09/27/2019 the facility failed to ensure that prescribed medications were 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. Evidence: RESIDENT #5 As evidenced by the photographs taken of the resident?s September 2019 medication administration record (MAR) on 09/27/2019, facility staff did not administer to resident #5 at noon on 09/27/2019 the 25 mg ? tablet of the medication Quetiapine. Resident #3- As evidenced by the photographs taken of the resident?s September 2019 medication administration record MAR) on 09/27/2019, facility staff did not apply at 2:00p.m on 09/20/2019 the medication Diclofenac to resident?s right knee, hip and left shoulder.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-680-H
Description:	Based on a review of the facility?s records with a facility Manager on 09/27/2019, the facility failed to document on a medication administration record (MAR) all medications administered to residents at the time the medication is administered. Evidence: Resident #1 (1)-As evidenced by the photographs taken on 09/27/2019 facility staff did not document whether the resident?s blood sugar was checked at 12:00p.m on 09/25, 26, 27/2019. (2)- As evidenced by the photographs taken on 09/27/2019 facility staff did not document at 8:00a.m on 09/23, 24, 26 27/2019; 09/23, 24, 26, 27/2019 at noon and 09/25, 26/2019 at 5:00p.m whether the resident?s FSBS was checked with meals and insulin was administered accordingly.
Plan of Correction:	Not available online. Contact Inspector for more information.