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COMMONWEALTH SENIOR LIVING AT HAMPTON
1030 TOPPING LANE
Hampton, VA 23666
(757) 826-3728

Current Inspector: Darunda Flint (757) 807-9731

Inspection Date: Nov. 12, 2019

Complaint Related: No

Areas Reviewed:
22VAC40-73 RESIDENT CARE AND RELATED SERVICES

Comments:
An unannounced focused monitoring inspection was conducted by two Licensing Inspectors from the Eastern Regional Office and the Peninsula Licensing Office on 11-12-2019 from 10:09 AM to 3:03 PM. There were 88 residents in care at the time of the inspection. A medication pass observation was conducted on the Assisted Living Unit and the Special Care Unit. 6 resident records, staff schedules, and time sheets were reviewed. Interviews were conducted. The areas of non-compliance were discussed with the Administrator throughout the inspection and during the exit interview. Items that could be used as potential restraints were also discussed with the Administrator. The facility received violations "under" Resident Care and Related Services. 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, 12-20-2019.

Violations:
Standard #: 22VAC40-73-650-A
Description: Based on record review and interview, no dietary supplement should be started by the facility without a valid order from a physician or other prescriber. Medications include prescription, over-the-counter, and sample medications.
Evidence:
1. During resident #1?s record review with staff #1 and staff #2, a signed physician?s order dated 06-12-2019 documented ?D/C Ensure, not needed.? The July and August 2019 Medication Administration Record (MAR) documented the resident received Ensure Enlive (Chocolate) on 07-01-2019 through 07-31-2019, and 08-01-2019 through 08-20-2019.
2. Staff #1 and staff #2 could not locate and/or provide a valid order to start resident #1?s Ensure Enlive (Chocolate) on 07-01-2019.
3. During interview, staff #1 and staff #2 acknowledged resident #1?s Ensure Enlive (Chocolate) was started without a valid order from a physician or other prescriber.
4. During resident #3?s record review with staff #1 and staff #2, a phone order dated 10-14-2019 documented ?D/C Culturelle? Rivastigmine?? The October and November 2019 documented the resident received the ?Culturelle Cap Immunity? and ?Rivastigmine Dis 9.5mg/24? patch on 10-14-2019 through 11-01-2019.
5. Staff #1 and staff #2 could not locate and/or provide a valid order to start resident #3?s Culturelle cap or Rivastigmine patch.
6. During interview, staff #1 and staff #2 acknowledged resident #3?s Culturelle Cap and Rivastigmine patch was started without a valid order from a physician or other prescriber.

Plan of Correction: Orders were obtained from the prescriber for Residents #1 and #3. All nurses and RMAs were re-in serviced on the requirement to ensure that no medications are started or changed by the community without a valid order from a prescriber. All medication administration orders were checked to ensure that a valid physicians order was present to ensure compliance. Licensed Nurse will continue to review all new medication orders in the Electronic Medication Administration Record and compare them to the physician's order and diagnosis prior to approving medication for administration to ensure ongoing compliance. Resident Care Director, Assistant Resident Care Director, or designee will complete monthly cart and chart audits and weekly med pass audit to ensure no medication is started without a valid order from a prescriber to ensure ongoing compliance with administration of medications and documentation.

Standard #: 22VAC40-73-650-C
Description: Based on record review and interview, the facility failed to ensure the physician's oral orders are reviewed and signed by a physician within 14 days.
Evidence:
1. During resident #3?s record review with staff #1 and staff #2, a phone order dated 10-14-2019 documented ?D/C: Culturelle, Donepezil, Ferrous, Rivastigmine, Tamsulosin, Change Omeprazole to Pepcid;? however, the order was not reviewed and signed by a physician within 14 days.
2. During interview, staff #1 and staff #2 acknowledged the phone order dated 10-14-2019 for resident #3 was not reviewed and signed by the physician within 14 days.

Plan of Correction: Signature for phone order was obtained from the prescriber for Resident #3. All nurses and RMAs were re-in serviced on the requirement to ensure all physician phone orders are reviewed and signed within 14 days of the original order. Licensed Nurse will continue to review all new medication orders/oral orders to ensure ongoing compliance. Resident Care Director, Assistant
Resident Care Director, or designee will complete chart audits to ensure all oral physician orders are reviewed and signed by a physician within 14 days.

Standard #: 22VAC40-73-680-D
Description: Based on observation, record review, and interview, the facility failed to ensure medications are administered in accordance with the physician's instructions.
Evidence:
1. During resident #2?s record review with staff #1 and staff #2, the current physician?s order on file dated 10-04-2019 documented ?DC current Seroquel order. Change Seroquel to 25mg 1t PO BID- Dementia with psychosis.? The October and November 2019 Medication Administration Record (MAR) documented ?Quetiapine 25mg tab (also known as Seroquel) take ? tablet = 12.5mg by mouth twice a day for Parkinson?s.? The October and November 2019 MAR?s also documented that the staff administered the ? tablet=12.5mg of Quetiapine to resident #2 during the scheduled 8:00 AM medication administration time on 10-01-2019 through 10-31-2019, and 11-01-2019 through 11-12-2019; and during the scheduled 5:00 PM medication administration time on 10-01-2019 through 10-31-2019, 11-01-2019 through 11-04-2019, and 11-06-2019 through 11-11-2019. The staff did not administer 1 tab of Quetiapine to equal 25mg per the physician?s instructions.
2. During interview, staff #1 and staff #2 acknowledged that the staff administered ? tablet=12.5mg of Quetiapine to resident #2 instead of 1 tablet=25mg. Staff #1 and staff #2 acknowledged that the staff did not administer resident #2?s Quetiapine in accordance with the physician?s instructions.
3. At approximately 12:17 PM, during the medication pass observation with staff #3 and staff #4, staff #3 was observed crushing resident #1?s medications and placing the medications in applesauce. Staff #3 was then observed administering the crushed medications with applesauce to resident #1
4. During resident #1?s record review, the current physician?s order on file dated 10-30-2019 documented ?May crush medication and mix in chocolate pudding. Chocolate pudding-family/resident request.? Resident #1?s medications were not placed in chocolate pudding per the physician?s instructions.
5. During interview, staff #1 and staff #4 acknowledged resident #1?s crushed medications were placed in applesauce instead of chocolate pudding.

Plan of Correction: Corrected orders were obtained from the prescriber for Residents #1 and #2. All nurses and RMAS were re-in serviced on the requirement to ensure that medications administered are in accordance with prescriber written order. All medication administration orders were checked to ensure that a valid physicians order was present to ensure compliance. Licensed Nurse will continue to review all new medication orders in the Electronic Medication Administration Record and compare them to the physician's order and diagnosis prior to approving medication for administration to ensure ongoing compliance. Resident Care Director, Assistant Resident Care Director, or designee will complete monthly cart and chart audits and weekly med pass audit to ensure no medication is started without a valid order from a prescriber to ensure ongoing compliance with administration of medications and documentation.

Disclaimer:
This information is provided by the Virginia Department of Social Services, which neither endorses any facility nor guarantees that the information is complete. It should not be used as the sole source in evaluating and/or selecting a facility.

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