VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Inspirit Hilltop Operator LLC
111 Denny Lane
Winchester, VA 22603
(540) 667-5323

Current Inspector: Laura Lunceford (540) 219-9264

Inspection Date: Oct. 28, 2019

Complaint Related: No

Areas Reviewed:

22VAC40-73 RESIDENT CARE AND RELATED SERVICES

Technical Assistance:

Discussion occurred on the following topics: 1) PRN blood glucose monitoring should also include signs and symptoms of hyperglycemia. 2) Ensure all sliding scale insulin orders have an area to document amount administered. 3) Ensure all results as it pertains to PRN medication administration are documented in a timely matter. Refer to MAR for resident C. 4) Review of temperature in memory neighborhood. 5) Ensure any activity change is reflected on all calendars for each floor.

Comments:

A focused monitoring inspection was completed on 10/28/19 as a follow-up to medication administration violations received at the renewal inspection on 08/09/2019. The facility was clean and free from any foul odors. All postings were current as were related drills. October medication administration records were reviewed for a selected number of residents. There was one repeat violation during this monitoring inspection. Details of non-compliance can be viewed in the violation notice section of this report. If you have any questions, contact the licensing inspector at (540) 332-2330 or email rhonda.whitmer@dss.virginia.gov.

Violations:

Standard #:	22VAC40-73-680-D
Description:	Based upon review of residents' Medication Administration Records (MARs), the facility failed to ensure medications are administered in accordance with the physician's instructions and consistent with the standards of practice outlined in the current registered medication aide curriculum. EVIDENCE: 1) Resident A has the following order: Blood sugar check and Novolog Flex Pen administer as follows: BS 150-199=1 Unit; 200-249=2 Units; 250-299=3 Units; 300-349=4 Units; Greater than 349=5 Units. a.Documentation in the MAR indicates resident's blood sugar was 248 on 10/17/19 at 11:30am and 3 units were administered. b.The order does not include administration by subcutaneous route or parameters when to notify the physician. 2) Resident B has the following order: Morphine Sulf IR 15mg-Take one tablet by mouth every four hours as needed for pain/fever. a. Documentation in the MAR indicates medication was administered on 10/08/19 at 2:39pm and again at 4:41pm. 3) Resident C has the following order: Acetaminophen 325mg-Take 2 tablets by mouth two times a day as needed for pain/fever. a. Documentation in the MAR indicates medication was administered on 10/4/19 at 12.07 for pain and fever. There is no documentation of temperature prior to administration or in results that were documented at 4:50pm. 4) Resident C has the following order: Metoprolol Tartrate 25mg-Take 1/2 tablet by mouth every 12 hours. a. Time of administration in MAR indicates 9:00am and 8:00pm. b. Documentation in MAR indicates medication was not available on 10/07/19 at 8:00pm; 10/08/19 at 9:00am; 10/15/19 at 8:00pm and 10/16/19 at 9:00am due to waiting on delivery. 5) Resident C has the following order: Quetiapine Fumarate 25mg-Take one by mouth at bedtime. a. Documentation in MAR indicates medication was not available on 10/07/19 and 10/08/19 due to waiting on delivery. 6) Resident C has the following order: Omeprazole 20mg-Take one capsule by mouth everyday. a. Documentation in the MAR indicates medication was not available on 10/28/19 at 9:00am due to waiting on delivery.
Plan of Correction:	Resident Wellness Directors will ensure that medications are administered 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. Resident Wellness Director has retrained Registered Medication Aides on the following topics: Hyperglycemia, Hypoglycemia, and Sliding Scale insulin administration.Resident Wellness Director has obtained orders for Insulin to be administered by subcutaneous route and parameters for blood sugars on when to notify the physician. Resident Wellness Director had the electronic medication administration system updated to include documentation of the following when administering PRN medications:Indication for use of the PRN medication and results/effectiveness of the PRN Medication. Resident Wellness Director has changed appropriate medication pass times to ensure compliance with physician orders. Resident Wellness Director has retrained the Registered Medication Aides on the following topic: Ordering/reordering medications.Resident Wellness Director will monitor medications and medication program daily to ensure compliance.