VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Harmony at Spring Hill
8350 Mountain Larkspur Drive
Fairfax, VA 22079
(571) 348-4970

Current Inspector: Amanda Velasco (703) 397-4587

Inspection Date: Oct. 10, 2019

Complaint Related: No

Areas Reviewed:

22VAC40-73 STAFFING AND SUPERVISION 22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-73 BUILDING AND GROUNDS 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS Article 1 Subjectivity

Comments:

An unannounced focused-monitoring inspection was conducted on 10/10/19, to follow-up on high-risk violations that were cited on 7/24/19. Building and grounds were inspected and facility documents were reviewed. The violation was 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 #:	22VAC40-73-680-D
Description:	Based on documentation, the facility failed to administer medications in accordance with the physician'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: The medication administration record (MAR) for Resident #1 was reviewed. The MAR calls for Resident #1 to receive 14 units of Humulin daily for diabetes. Resident #1's blood sugar is checked three times per day, and he may receive additional Humulin, based on a sliding scale. The sliding scale states that six units of Humulin should be given for blood sugars ranging between 301 and 350. On 10/6/19 (5 PM administration), the MAR lists Resident #1's blood sugar as 322 with a sliding scale dosage of eight units being given. On 10/8/19 (7 AM administration), the MAR lists Resident #1's blood sugar as 318 with a sliding scale dose of 14 units being given. The MAR for Resident #2 was reviewed. Resident #2 has his blood sugar checked before meals and the MAR calls for him to receive Novolog, based on a sliding scale. On 10/7/19 (4:30 PM administration), the MAR lists Resident #2 as having a blood sugar of 250 with a sliding scale dosage of four units being given. The sliding scale states that no Novolog should be given for blood sugars ranging from 200 and 250. The MAR for Resident #3 was reviewed. The MAR states that Resident #3's daily doses of Amlodipine and Hydrochlorothiazide should be held if the resident's systolic blood pressure (SBP) is less than 110 or heart rate (HR) is below 60. The MAR lists Resident #3 as receiving both Amlodipine and Hydrochlorothiazide on the following dates: 10/1/19 (pulse listed as 52), 10/2/19 (pulse is listed as 53), 10/3/19 (pulse is listed as 55), 10/4/19 (pulse is listed as 51), 10/7/19 (pulse is listed as 51), 10/8/19 (pulse is listed as 53), 10/9/19 (pulse is listed as 58), and 10/10/19 (pulse is listed as 57).
Plan of Correction:	10/16/19: Staff received additional training from Regional Clinical Nurse. Orders reviewed with physician. 10/30/19: Staff received corrective action. 10/23/19: Residents physician revised order Amlodipine to read hold if systolic blood pressure is less than 100. No heart rate parameters for Amlodipine. Residents physician revised order Hydrochlorothiazide to read take one tab per day no parameters.