VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Harmony at Chantilly
2980 Centreville Road
Herndon, VA 20171
(703) 994-4561

Current Inspector: Amanda Velasco (703) 397-4587

Inspection Date: Sept. 25, 2019

Complaint Related: No

Areas Reviewed:

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

Comments:

An unannounced focused-monitoring inspection was conducted on 9/25/19, to follow-up on high-risk violations that were cited on 7/24/19. Building and grounds were inspected. Medication administration and resident records were observed. Physician's orders were reviewed. The 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 #:	22VAC40-73-660-A-1
Description:	Based on observation, the facility failed to ensure that a medicine cabinet is used for the storage of medications and dietary supplements prescribed for residents when such medications and dietary supplements are administered by the facility. Medications shall be stored in a manner consistent with current standards of practice. Evidence: Nystatin-Triamcinolone and Clotrimazole creams were observed unlocked and unattended in the bedroom of Resident #2. Resident #2's uniform assessment instrument (UAI), dated 6/21/19, states that the resident needs staff assistance for medication administration.
Plan of Correction:	Nystatin-Triamcinolone cream and Clotrimazole cream were immediately removed from Resident #2?s room, and placed inside the locked medication cart. The HCC and ED checked the rooms of other residents to confirm that no medications or creams were present. No issues were identified. Staff were re-educated. The HCC, ED and designees will conduct frequent room audits to verify that no medications or creams are present.
Standard #:	22VAC40-73-680-D
Description:	Based on observation and record review, the facility failed to ensure that 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. Evidence: Resident #1 receives Lisinopril and Amlodipine Besylate daily for hypertension. Resident #1's record contained an order, dated 9/17/19, that calls for the resident's blood pressure medications to be held when the resident's systolic blood pressure (SBP) is less than 90 or the diastolic blood pressure (DBP) is less than 60. Resident #1's medication administration record (MAR) was reviewed during the inspection. Resident #1's MAR states that the resident's Amlodipine Besylate was given on 9/19/19 (DBP: 50) and 9/24/19 (DBP: 45). The MAR also states that the resident's Lisinopril was given on: 9/19/19 (DBP: 50), 9/20/19 (DBP: 55), 9/22/19 (DBP: 50), 9/24/19 (DBP: 45), and 9/25/19 (DBP: 50).
Plan of Correction:	Resident #1 has a physician signed order for Lisinopril and Amlodipine, (with parameters respectively), in the medical chart, prescribed by the Hospice provider. The Healthcare Coordinator (HCC) and Executive Director, (ED) performed an audit to confirm that there are current orders for parameters in resident charts, for those requiring parameters. No issues were identified. Staff were re-educated. The HCC will verify the orders for medication parameters upon admission, and will verify new orders for parameters due to change in condition and will confirm the orders are accurately implemented. The HCC or designee will audit parameter orders monthly for three months to confirm the orders are complete and signed and will report the results to the leadership team. During and at the end of the 3 months, the leadership team will evaluate the results of the audits and determine if additional focus or action is warranted. The Executive Director (ED), or designated Coordinator is responsible for confirming implementation and ongoing compliance with the components of this Plan of Correction and addressing and resolving variances that may occur.