VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Bickford of Virginia Beach
2629 Princess Anne Road
Virginia beach, VA 23456
(757) 821-0198

Current Inspector: Willie Barnes (757) 439-6815

Inspection Date: Dec. 19, 2019

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 ADMISSION, RETENTION, AND DISCHARGE OF RESIDENTS 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 complaint investigation was conducted on 12-19-2019 from 8:25 AM to 1:04 PM, in response to allegations relating to the discharge process, staff quantity, laundry/housekeeping, and medication administration. 31 residents were in care at the time of the investigation. A tour of the facility was conducted. The following was reviewed: resident records, Medication Administration Record?s, physicians? orders, and staff schedules/time sheets. Interviews were conducted with staff and residents. Documentation supported the facility had the required number of staff during all shifts. The following areas could not be determined during the investigation: medication administration and the discharge process. The following was discussed with the Administrator: staff schedules, required paperwork for residents admitting into the special care unit, storage of cleaning supplies and medications, resident elopements, sex offender screenings, and housekeeping services.The facility received violations "under" Admission, Retention, and Discharge of Residents, Resident Care and Related Services, Buildings and Grounds, and Additional Requirements for Facilities that Care for Adults with Serious Cognitive Impairments. The areas of noncompliance were reviewed with the Administrator throughout the inspection and during the exit interview. Based on this investigation, the complaint is 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, 02-13-2020.

Violations:

Standard #:	22VAC40-73-1090-A
Complaint related:	No
Description:	Based on record review and interview, the facility failed to ensure prior to admission to a safe, secure environment, the resident is assessed in writing by an independent physician as having a serious cognitive impairment due to a primary psychiatric diagnosis of dementia with an inability to recognize danger or protect his own safety and welfare. Evidence: 1. During resident #2?s record review with staff #1 and staff #2, the resident admitted to the facility on 11-24-2019, and was placed on the special care unit (Mary B?s) upon admission. Staff #1 and staff #2 could not locate and/or provide documentation indicating an assessment of serious cognitive impairment was completed by a physician prior to resident #2 admitting to the special care unit. 2. During interview, staff #1 and staff #2 acknowledged there was no documentation on file to verify resident #2 was assessed by an independent physician as having a serious cognitive impairment due to a primary psychiatric diagnosis of dementia with an inability to recognize danger or protect his own safety and welfare.
Plan of Correction:	*Resident #2 was a direct admission from our sister community?s Special Care Unit, located in Suffolk, VA. The Assessment of Serious Cognitive Impairment, completed by her physician prior to admission, was located within her thinned chart and is now a part of her active medical record. *A 100% audit was conducted of all Mary B?s medical records to assure that the Assessment of Serious Cognitive Impairment is contained within each medical record.
Standard #:	22VAC40-73-320-A
Complaint related:	No
Description:	Based on record review and interview, the facility failed to ensure within the 30 days preceding admission, a person should have a physical examination by an independent physician. The report of such examination should contain the results of a risk assessment documenting the absence of tuberculosis in a communicable form as evidenced by the completion of the current screening form published by the Virginia Department of Health or a form consistent with it. Evidence: 1. During resident #2?s record review with staff #1 and staff #2, the resident admitted to the facility on 11-25-2019. The date of the physical examination on file was 10-08-2019 and was not within 30 days preceding admission. Additionally, there was no documentation on file of a current screening containing the results of a risk assessment documenting the absence of tuberculosis (TB) in a communicable form. 2. During interview, staff #1 and staff #2 acknowledged resident #2?s physical examination was not within 30 days preceding admission and acknowledged there was no documentation on file of a TB screening.
Plan of Correction:	*The facility received DSS sponsored training on 1/22/20 which included the proper procedures to follow when the physical exam date exceeds 30 days prior to admission. *Documentation, per DSS instruction, was obtained by resident #2 physician. *A 100% audit of all admission physical examinations was conducted to assure that all physical exam dates were compliant per DSS regulations. *All future physical exam forms will be reviewed prior to move in to assure that the physical exam date is within 30 days of move in.
Standard #:	22VAC40-73-460-D
Complaint related:	No
Description:	Based on record review and interview, the facility failed to provide supervision of resident schedules, care, and activities, including attention to specialized needs to prevent wandering from the premises. Evidence: 1. The staff ?Communication Log? documented room #503 (confirmed by staff #1 as resident #1) had exit seeking behaviors on 11-23-2019, 11-24-2019, and 12-03-2019; which were prior to resident #1?s elopements on 11-26-2019 and 12-05-2019. On 11-23-2019, resident #1 is ?still exit seeking? during the day shift, and was ?exit seeking? and ?got a hold of some sharp scissors and broke in closet? Also found a butter knife?? during the night shift. On 11-24-2019, resident #1 is ?exit seeking? during the day shift, and ?started exit seeking around dinner time? during the evening shift. On 12-03-2019, resident #1 ?Removed GPS monitor off x2. Made several attempts to open window? during the evening shift. 2. Staff #1 provided copies of ?Incident Reports? regarding resident #1?s elopements from the special care unit (Mary B?s) on 11-26-2019 and 12-05-2019 documenting the following: A. The written report dated 12-02-2019 regarding the incident that occurred on 11-26-2019 documented, ?? At 7:15 a.m. the oncoming shift made rounds and observed that [resident] was not in [resident?s] room. The window was forced open beyond the safety locks, and the screen had been pushed out. A search was conducted, and the resident was found on North Landing Road by the Maintenance Director, less than half of a mile from the community?? B. The written report dated 12-12-2019 regarding the incident that occurred on 12-05-2019 documented, ?? At 8:30 a.m. the RMA went to do [resident?s] scheduled check, and [resident] has barricaded [resident?s] door with a chair and a piece of furniture. Upon entry into the room, it was observed that the window on the left side was open, and the screen was pushed out. [Resident] was gone? She (staff #1) located [resident] on the corner of Princess Anne Road and North Landing Road at 9:06 a.m.? 3. The distance from the facility (Princess Anne Road) to North Landing Road is approximately .7 miles. In addition, the roads that surround the facility are: Princess Anne Road and Nimmo Parkway with a speed limit range of 35 mph to 55 mph; and West Neck Road with a speed limit of 35 mph. 4. During resident #1?s record review with staff #1, the current ISP on file dated 11-23-2019 documented the resident has ?some wandering behaviors.? The ?Progress Notes? documented the resident had other elopement incidents on 11-17-2019 at approximately 6:45 AM, and on 11-19-2019 at approximately 7:45 AM. 5. During interview, staff #1 acknowledged that staff were aware of resident #1?s aforementioned exit seeking behaviors and had previous elopements in the mornings. Staff #1 acknowledged that the facility did not provide attention to the resident?s specialized needs to prevent wandering from the premises.
Plan of Correction:	*On 12/13/19, an emergency Care Plan Meeting was held with the Power of Attorney for Resident #1. She was issued a notice of discharge for the safety of Resident #1. A more fortified environment was recommended. *On 12/13/19, the facility provided the Power of Attorney with a list of communities that had extensive fencing surrounding their Special Care Units, to include 2 communities who had Special Care Units located on upper levels of their communities, as an added level of protection to the resident who continued to be fixated on exiting the facility. *At the request of the Power of Attorney on 12/13/19, the community again discussed medication changes with the physician of resident #1. There were no new orders. *The community provided private duty 1:1 supervision for resident #1 for 24 hours a day starting on 12-11-19 which continued until his discharge on 12/31/19. *Supervision checks by facility staff of resident #1 were increased to every 30 minutes, in addition to the 1:1 supervision provided by private duty sitters, as an added level of supervision for his safety.
Standard #:	22VAC40-73-650-A
Complaint related:	No
Description:	Based on record review and interview, the facility failed to ensure no medication is started by the facility without a valid order from a physician or other prescriber. Evidence: 1. During resident #1?s record review with staff #1 and staff #2, Trazadone 50mg was administered to the resident without a valid order from a physician or other prescriber. The December 2019 Medication Administration Record (MAR) documented staff administered Trazadone 50mg on 12-07-2019 through 12-17-2019. Staff #1 and staff #2 could not locate and/or provide a valid order on file to start the Trazadone 50mg. 2. During interview, staff #1 and staff #2 acknowledged resident #1?s Trazadone 50mg was started by the facility without a valid order from a physician or other prescriber.
Plan of Correction:	*The physician?s original order/prescription for Trazadone 50mg 1 tab at bedtime was received by the facility on 12/6/19, prior to administration, and received by the pharmacy at 3:56 CST via fax on 12/6/19 so that it could be filled, delivered, and administered as ordered by the physician. *A duplicate of this order was provided to the facility by the pharmacy on 12/19/19 within an hour of the conclusion of this inspection and was properly noted and filed within the medical record. *The RNC and ACC were instructed on the importance of accurate and timely filing of information into the medical records and how to more expeditiously obtain copies of documents under similar circumstances.
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. During the tour of the special care unit (Mary B?s) with staff #3, the following was observed: A. A tube of Protective Ointment was located on top of the bathroom vanity in resident #3?s room (#511). B. In resident #2?s room (#514), a bathroom cabinet was left unlocked and open, containing a bottle of Peroxide, Calmoseptine Ointment, 2 bottles of Wound Cleanser, and a bottle of Antimicrobial Cleanser. 2. During resident record review with staff #3, resident #2?s current UAI dated 11-24-2019, and resident #3?s current UAI dated 12-15-2019 documented for medications to be administered by professional nursing staff. 3. During interview, staff #3 acknowledged resident #2 and resident #3 were not permitted to keep medications in the room.
Plan of Correction:	*Residents #2 and #3 immediately had the identified items relocated to the locked cabinets located within their private bathrooms. *Staff and health care vendors instructed on the requirement to assure that all medicines/ointments/etc. are properly stored and secured in the locked cabinets within each Mary B?s resident?s bathrooms. *Resident Daily Task Sheets were modified to include daily checks, per shift, for any items that require secure storage.
Standard #:	22VAC40-73-680-D
Complaint related:	No
Description:	Based on 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 signed physician?s orders on file dated 10-08-2019 documented ?Clonidine Dis 0.1/24 hr- Apply one patch once a week for HTN.? The November and December 2019 Medication Administration Record documented staff applied the Clonidine patch to resident #2 on 11-29-2019, 12-06-2019, 12-07-2019, and 12-14-2019. 2. During interview, staff #1 and staff #2 acknowledged resident #2?s Clonidine patch was not administered in accordance with the physician?s instructions.
Plan of Correction:	*Clonidine Dis. 0.1/24 hr patch ? apply weekly, that was applied on 12/6/19, was no longer on the resident on 12/7/19. A new patch was applied on 12/7/19. The provider has been notified. *Registered Medication Aides have been instructed to report to the RN Coordinator when a prescribed medication patch is removed/falls off prior to the date that it is to be replaced so that proper documentation can occur on the MAR and the physician can be notified and give new orders, if indicated.
Standard #:	22VAC40-73-860-I
Complaint related:	No
Description:	Based on observation and interview, the facility failed to store cleaning supplies and other hazardous materials in a locked area. Evidence: 1. During the tour of the special care unit (Mary B?s) with staff #3, a bottle of Pine Sol and a container of disinfectant wipes were observed on the floor near the toilet in room #511. 2. During interview, staff #3 acknowledged the bottle of Pine Sol and container of disinfectant wipes were not stored in a locked area.
Plan of Correction:	*All Mary B?s family members were reminded, in writing, of the requirement to not bring cleaning products into the community and the regulation that all such items be properly stored under locked conditions. *Documentation with a signed acknowledgement of the requirement that any/all cleaning products be properly stored under locked conditions will be obtained at the time of admission. *Resident Daily Task Sheets were modified to include daily checks, per shift, for any items that require secure storage.
Standard #:	22VAC40-73-870-E
Complaint related:	Yes
Description:	Based on observation and interview, the facility failed to ensure all toilets are kept clean. Evidence: 1. During the tour of the facility with staff #3, a brown substance was observed on the rim of the toilet seats and on the inside of the toilets in room #508 and room #511. There was also a brown substance that was splattered on the inside the toilet in room #516. 2. During interview, staff #3 acknowledged the brown substance located on the aforementioned toilets.
Plan of Correction:	*New facility has added additional staff members, in conjunction with increasing occupancy, who are assigned strictly to housekeeping tasks. *Housekeeping cleaning schedule was updated, in conjunction with resident services plans and accurately addresses housekeeping needs. *Housekeeping staff members were oriented to the cleaning schedules and are now incorporated in the daily standup meetings and share issues that impact the residents needs as they pertain to housekeeping