VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Riverside Assisted Living at Warwick Forest
860 Denbigh Blvd.
Newport news, VA 23602
(757) 886-2000

Current Inspector: Willie Barnes (757) 439-6815

Inspection Date: Sept. 12, 2019 and Oct. 2, 2019

Complaint Related: Yes

Areas Reviewed:

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

Comments:

An unannounced complaint inspection was conducted by the Licensing Inspector from the Eastern Regional Office on 09-12-2019 from 11:44 AM to 4:43 PM and on 10-02-2019 from 11:22 AM to 3:15 PM. The complaint alleged concerns with Staffing and Supervision, Resident Care and Related Services, and Buildings and Grounds. There were a total of 124 residents in care at the time of the inspection. A tour of the facility was conducted and call bells in resident rooms were sampled. The following was reviewed: 4 resident records, staff schedules and time sheets, shower schedules, and call bell logs. Interviews were also conducted. The facility received violations "under" Resident Care and Related Services and Buildings and Grounds. The following was discussed with the Administrator: call bell systems, ISP's, and services provided by the facility. The areas of noncompliance were reviewed with the Administrator throughout the inspection and during the exit interview. Based on the information reviewed during this inspection,a portion of the complaint was found to be valid. Please complete the -Plan of Correction- for each violation cited on the violation notice and return it to me within 10 calendar days from today, 10-21-2019.

Violations:

Standard #:	22VAC40-73-450-E
Complaint related:	Yes
Description:	Based on record review and interview, the facility failed to ensure the individualized service plan (ISP) was signed and dated by the licensee, administrator, or his designee, (i.e., the person who has developed the plan), and by the resident or their legal representative. Evidence: 1. On 09-12-2019, during resident #1?s record review with staff #1, the comprehensive ISP dated 07-01-2019 was not signed or dated by the person who developed the plan, or by the resident and/or legal representative. 2. During interview on 09-12-2019, staff #1 acknowledged resident #1?s ISP was not signed or dated by the person who developed the plan, or by the resident and/or legal representative.
Plan of Correction:	Resident #8?s Individualized Service Plan (ISP) was reviewed by the nurse manager/designee. The resident and resident representative were notified of the missing care plan approval. Immediate care plan meeting arranged and resident?s ISP completed and signed by all parties. A 100% audit of the past 3 months Individualized Service Plan (ISPs) will be completed for missed approvals by the unit managers/designees. All findings will be corrected and reported to the QA Committee for continued improvement and analysis. Education regarding ISP updates and approval process will be provided to the nursing staff by the facility educator. The process will be reviewed by the Administrator/designee monthly for 2 months with an audit of 6 ISPs. All findings will be corrected and reported to the QA Committee for continued improvement and analysis.
Standard #:	22VAC40-73-660-B
Complaint related:	No
Description:	Based on observation, record review, and interview, the facility failed to ensure the resident was permitted to keep their own medication in an out-of-sight place in their room if the Uniform Assessment Instrument (UAI) has indicated that the resident is capable of self-administering medication. Evidence: 1. On 09-12-2019, during the tour of the facility with staff #1, a bottle of Miralax was observed on in resident #1?s bathroom, and a bottle of Nitroglycerine was observed on resident #2?s nightstand. 2. On 09-12-2019, during resident record review with staff #1, resident #1?s UAI dated 08-08-2019 and resident #2?s UAI dated 09-08-2019 documented for medications to be administered by a lay person and/or professional nursing staff; and did not document that either resident is capable of self-administering medications. 2. During interview on 09-12-2019, staff #1 acknowledged resident #1 and resident #2 were not permitted to keep medications in their room based on the UAI.
Plan of Correction:	Immediate correction was done 9/12/19. The identified medications found in Resident #1 and # 2?s room was removed and secured. All residents? apartments will be screened by nurse manager/designee for unapproved medications. Findings will be corrected and communicated to the physicians, resident representative, and nursing staff. All findings and corrective actions will be reported to the QA Committee for continued improvement and analysis. Information regarding approved storage of medication will be provided to the residents, residents? representative, physicians, and the nursing staff by the Administrator/designee. Unit managers/designee will review POS orders monthly; will assure appropriate medication orders are in place for any new and over the counter medication, update the Medication Administration Records (MAR), and POSs are signed by the PCPs. The process will be reviewed by the Administrator/designee by screening 12 residents? apartments monthly for 2 months. All findings will be corrected and reported to the QA Committee for continued improvement and analysis.
Standard #:	22VAC40-73-680-I
Complaint related:	No
Description:	Based on record review and interview, the facility failed to ensure the Medication Administration Record (MAR) included the date and time given and initials of direct care staff administering the medication. Evidence: 1. On 10-04-2019, during resident #1?s record review with staff #1, the following dates on the August and September 2019 MAR?s were blank and did not include the initials of direct care staff administering the medication: A. August 2019 MAR: Ferrous Sulfate 325mg during the 8pm administration time on 08-10-2019 and 08-11-2019; and Check BP during 1700 on 08-16-2019 and 08-25-2019. B. September 2019 MAR: Quetiapine 25mg during the 2000 administration time on 09-11-2019, 09-13-2019, and 09-26-2019; Lidocaine 4% patch during the PM administration time on 09-13-2019; Atorvastatin 10mg during the 2000 administration time on 09-13-2019; and Ferrous Sulfate 325mg during the 8pm administration time on 09-13-2019. 2. During interview, staff #1 acknowledged the aforementioned dates on resident #1?s August and September 2019 MAR?s were blank and did not include the staffs initials.
Plan of Correction:	Resident #1?s MAR was reviewed by the nurse manager/designee. The resident?s representative and physician were notified of the missed documentation of administration. A 100% audit will be completed of the current month of all residents? MAR for missed documentation by unit managers/designees. All findings will be corrected and reported to the QA Committee for continued improvement and analysis. Education regarding medication administration and record keeping provided to the nursing staff by the nurse managers. Nurses and RMAs will be observed by the pharmacy every 3 months and facility educator will conduct random medication administration observation. The process be reviewed by the Administrator/designee monthly for 2 months with an audit of 12 MARs. All findings will be corrected and reported to the QA Committee for continued improvement and analysis.
Standard #:	22VAC40-73-870-E
Complaint related:	Yes
Description:	Based on record review and interview, the facility failed to ensure all equipment was in good repair. Evidence: 1. On 08-29-2019, the Licensing Inspector received a final incident report from the facility documenting ?On 08-22-2019 during the rounds, resident #1 was found on the floor in her apartment? The resident stated that she used the pull cord to call for help after she had fallen; however, the staff did not receive any calls from the resident?s room? The pull cord was evaluated by the staff at the time of the fall and the manager upon arrival to the facility and was determined to not be functioning appropriately... 911 was called and the resident was transferred to [hospital]?? 2. On 09-12-2019, during review of the ?24 Hour Shift Report? with staff #1, the shift report documented the following: A. On 08-19-2019 during the 3pm-11pm shift resident #1 ?Pulled cord @ 830pm. I had walkie next to me downstairs and didn?t hear her room # come across.? B. On 08-21-2019 during the 11pm to 7am resident #1?s ?Call bell is broken. Reset and still not coming across computer?? and another note below documenting resident #1 ?Fall, transported to [hospital] per residents request?? 3. During interview on 09-12-2019, staff #1 confirmed resident #1?s call bell was not working at the time the resident fell on 08-22-2019. 4. On 09-13-2019, the Licensing Inspector received another final incident report from the facility documenting ?The call bell logs were reviewed 8/01/19 through 8/26/19. The follow up checks revealed that the signal did not go through the system consistently.?
Plan of Correction:	Immediate correction was done on 8/22/2019. System provider evaluated the pull cord and pendant alarm of the resident#1?s. It is identified that the problem was related to the low battery of the radios and pendant alarm. Nurse managers/designee will test the system periodically by pulling the cords and pressing the pendant alarms to ensure the alarm system is working. Daily call bell reports, including low battery warnings, will be reviewed by the administrator/designee and all findings will be communicated to the unit managers and the maintenance director daily. All findings will be corrected and reported to the QA Committee for continued improvement and analysis. Facility educator will include a training related to the call bell checks, charging radios, ordering placement and back up call bells. Administrator/designee will monitor the system by pulling the alarm cord randomly for 2 months to test the system consistency. All findings will be corrected and reported to the QA Committee for continued improvement and analysis.