VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Dogwood Crossing Senior Living And Memory Care
130 Deer Ridge Trail
Tazewell, VA 24651
(276) 385-7150

Current Inspector: Rebecca Berry (276) 608-3514

Inspection Date: Jan. 24, 2020

Complaint Related: No

Areas Reviewed:

22VAC40-73 STAFFING AND SUPERVISION 22VAC40-73 ADMISSION, RETENTION, AND DISCHARGE OF RESIDENTS 22VAC40-73 RESIDENT CARE AND RELATED SERVICES

Comments:

Two licensing inspectors conducted an unannounced monitoring inspection regarding a self-reported incident at Dogwood Crossing on 01/24/2020. The focus of this inspection was to determine compliance with standards using the most recent inspection protocol.The inspection started at 1:00 pm and concluded at 2:25 pm. During the inspection the resident record and additional documents were reviewed. Staff and resident interviews were conducted. An exit meeting was held with the administrator on 01/24/2020 and at that time an opportunity was given to find items not available during the inspection. As a result of this inspection 4 violations are being cited. An Intensive Plan of Correction (IPOC) will need to be submitted. There will be a meeting held in the Western Regional Licensing Office on February 12, 2020 at 1:00 pm regarding the IPOC. The IPOC is due back to the licensing office on 02/21/2020. If you have any questions or concerns please contact your inspector at 276-608-3514.

Violations:

Standard #:	22VAC40-73-300-B
Description:	Based on documentation review, the facility failed to document in the communication log incidents related to physical or mental conditions. EVIDENCE: 1. Resident #1 was admitted to the facility on August 3, 2018. According to physician's notes dated 08/20/2018 she has a diagnosis of Dementia without behavioral disturbance and Alzheimers; unspecified . 2. According to staff interviews this resident has not had wandering or exit seeking behaviors in the past. Resident #1 did exit the building unattended and unsupervised on January 15, 2020 at 1:35 pm per video surveillance and sat in a staff member's vehicle from the time she exited the building to the time she was seen re-entering the building at 3:20 pm. 3. Staff # 2 reviewed the communication log book while licensing inspectors were present and she could not find documentation regarding this incident so that other direct care staff would be aware of this incident.
Plan of Correction:	Please see Intensive Plan of Correction.
Standard #:	22VAC40-73-450-H
Description:	Based on review of the resident record and the Individualized Service Plan (ISP); the facility failed to ensure the care and services specified in the ISP are provided to one resident in care. EVIDENCE: 1. Resident # 1 was admitted to the facility in August 2018. She has a diagnosis of Dementia without behavioral disturbances and Alzhiemers; unspecified. 2. The ISP for this resident dated 08/03/2019 states this resident is checked on every two hours and as needed due to her not being able to utilize the call system. 3. This resident had an incident on January 15, 2020 where she exited the building at 1:35 pm and was sitting in a staff member's vehicle from the time she exited to the time she was brought back into the facility at 3:20 pm according to staff #1. According to documentation review and staff interviews this resident had never displayed any wandering or exit seeking behaviors. 4. The staff were not aware that the resident was missing from 1:35 pm until staff #3 discovered she was not in her room at 2:40 pm. The resident entered back into the facility at 3:20 pm.
Plan of Correction:	Please see Intensive Plan of Correction.
Standard #:	22VAC40-73-460-A
Description:	Based on review of resident record,documentation review,and staff interviews, the facility failed to assume general responsibility for the health, safety and well-being of one resident. EVIDENCE: 1. Resident #1 was admitted to the facility on August 3, 2018. According to physician notes dated 08/20/2018 she has a diagnosis of Alzheimer disease, unspecified and Dementia. Also, in her pre-admission paperwork it stated this resident had her right hand amputated due to injuries from a burn. 2. The Uniform Assessment Instrument (UAI) for this resident dated 08/03/2019 states this resident is disoriented to some spheres some of the time. The Individual Service Plan (ISP) for this resident dated 08/03/2019 states this resident is to be checked on every two hours or as needed by staff as she is unable to use her call system. 3. According to information given to the licensing inspector by staff #1 this resident exited the building by herself on January 15, 2020. Staff #1 stated that this resident was seen via video surveillance exiting the building at 1:35 pm and not being brought back into the facility until 3:20 pm. According to staff # 1 this resident had not displayed any wandering or exit seeking behaviors prior to this incident. The resident was told earlier that day she had an upcoming doctors appointment. When she exited the building at 1:35 pm she was seen via video surveillance getting into staff # 3's car. The resident was in the vehicle of this staff member from the time she exited the building until the time she was brought back into the facility. 4. At 2:40 PM it is documented staff #3 went to check on resident #1 and she was not in her room. 5. Staff #3 stated she looked out of the window and saw the resident in this staff members car. This resident was seen on video surveillance re-entering back the building with staff # 3 at 3:20 pm. 6. According to weather channel report for January 15, 2020 the high temperature was 59 degrees and a low of 44 degrees with fog and wind. 7. Staff #1 stated resident #1 was observed on video surveillance to be wearing red long pants, a white shirt with print near the chest area and a cream colored sweater when she exited the building.
Plan of Correction:	Please see Intensive Plan of Correction.
Standard #:	22VAC40-73-460-E
Description:	Based on review of resident record and documentation review, the facility failed to document any notable change in resident's condition or functioning including altered behavior and any corresponding action taken in the resident's record. EVIDENCE: 1. Resident #1 has a diagnosis of Dementia and Alzheimer's; unspecified. According to documentation review and staff interviews she had not displayed any wandering or exit seeking behaviors since she was admitted to the facility on August 3, 2018. 2. Resident # 1 exited the building on 01/15/2020 at 1:35 pm and was found at 3:20 pm in a staff person's car and brought back into the facility. 3. On the day of the inspection 01/24/2020, there was no documentation in this resident's file regarding the incident of her exiting the building on January 15, 2020.
Plan of Correction:	Please see Intensive Plan of Correction.