VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Riverside Assisted Living at Warwick Forest
860 Denbigh Blvd.
Newport news, VA 23602
(757) 886-2000

Current Inspector: Willie Barnes (757) 439-6815

Inspection Date: Jan. 2, 2020

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 RESIDENT CARE AND RELATED SERVICES

Comments:

An unannounced complaint investigation was conducted on 01-02-2020 from 11:49 AM to 2:21 PM in response to an allegation of medications not received. 122 residents were in care at the time of the inspection. The following was reviewed: resident records, medications, physician's orders, and Medication Administration Records. Interviews were conducted. Documentation reviewed supported residents received medications. Based on this investigation, the complaint is not valid, however,the facility received other violations "under" Resident Care and Related Services. The areas of noncompliance were reviewed with the Administrator throughout the inspection and during the exit interview. 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, 03-02-2020.

Violations:

Standard #:	22VAC40-73-650-B
Complaint related:	No
Description:	Based on record review and interview, the facility failed to ensure the physician?s orders both written and oral, for administration of all prescription medications identified the diagnosis. Evidence: 1. During resident #1?s record review with staff #1, the following signed physician?s prescriptions dated 10-30-2019 did not include a diagnosis: Midodrine 5mg, Carbidopa-levodopa 48.75-195mg, Fludrocortisone 0.1mg, and Rivastigmine 9.5mg. 2. During interview, staff #1 staff #1 acknowledged resident #1?s physician?s prescriptions dated 10-30-2019 did not include a diagnosis for the aforementioned medications.
Plan of Correction:	1. Resident #3?s physician was contacted by the Unit Manager for clarification of the diagnosis on the order. This has been corrected. 2. Physicians will be notified by letter by the administrator that any medication that shall be administered in our facility must have a diagnosis listed for each medication. An audit of the last 30 days will be completed by the Administrator/designee to ensure that all prescribed medication has the proper diagnosis listed. 3. All LPN and Medication Aides will be re-educated by the Nurse Educator that any new medication presented for administration must have a listed diagnosis for each medication. 4. A weekly audit of up to 10 new residents will be completed by the Administrator/or designee with new orders for 4 weeks to ensure all required signatures are present. All findings will be corrected and reported to the QA Committee for continued improvement and analysis.
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, the physician?s order dated 11-26-2019 documented to increase the Levothyroxine 25mcg to ?Levothyroxine (Synthroid, Levothyroid) 50mcg tablet- Take 1 tablet (50mcg total) by mouth every morning at 0600?? The November 2019 Medication Administration Record documented staff administered 1 tablet of Levothyroxine 25mcg to the resident at 0600 on 11-27-2019 through 11-30-2019, instead of Levothyroxine 50mcg. 2. During interview, staff #1 acknowledged that the staff did not administer resident #2?s Levothyroxine 50 mcg in accordance with the physician?s instructions.
Plan of Correction:	1. All Licensed Practical Nurses and Medication Aides will be required to take a refresher course on medication administration to ensure understanding medication administration according to their scope of practice. This class with be conducted by the Nurse Educator. Resident #2?s chart has been reviewed. Resident #2 was discharged from the community prior to the inspection. 2. All medication changes will be documented in the resident record then placed on the Medication Administration Record. Any orders that are no longer in place will be discontinued per the prescriber?s orders and documented. Unit managers/designees will follow up on any new orders to ensure that proper procedures have been completed. Pharmacy will be notified of any changes by the Unit Manager/designee. 3. Residents identified as having a new order will be flagged by the Licensed Practical Nurse or Medication Aide to alert other team members. All new orders will be documented on the 24 hour report immediately. The Unit Managers or designee will ensure that all new orders are transcribed correctly and the proper notifications are completed. 4. The Unit Managers or designee will conduct a random audit of 10 residents for six (6) weeks to ensure that medication is administered by the appropriate healthcare professional. All findings will be corrected and reported to the QA Committee for continued improvement and analysis.
Standard #:	22VAC40-73-680-I
Complaint related:	No
Description:	Based on record review and interview, the facility failed to ensure the Medication Administration Record (MAR) included the initials of direct care staff administering the medication. Evidence: 1. During resident record review with staff #1, the following dates on the November and December 2019 MAR?s for resident #1 and the December 2019 MAR for resident #3 did not include the initials of direct care staff for the following medications: A. Resident #1?s Rytary cap 48.75/195mg on 10-18-2019 and 10-26-2019 at 1200; Quetiapine 25mg tab on 10-17-2019 at 2000; Atorvastatin 20mg and Rivastigmine patch at 2000 on 10-21-2019 and Tylenol 325mg tab on 10-20-2019 and 10-29-2019 through 10-31-2019 at 2300; Midodrine 5mg on 11-05-2019 and 11-22-2019 at 1200; Fludrocortisone 0.1mg, Midodrine 5mg, and Rytary 48.75/195 mg on 12-11-2019 at 1200; Midodrine 5mg on 12-23-2019 at 1700; and Rytary 48.75/195 mg on 12-23-2019 at 2000. B. Resident #3?s Certa-Vite Senior w/Lutein tab, Citrucel Powder SF, Famatodine 20mg tab, Flonase 50mcg spray, Losartan 150mg tab, Prosight tab, and Vitamin B Complex Tab on 12-26-2019 at 0900; and Losartan 150mg tab on 12-27-2019 at 0900. 2. During interview, staff #1 acknowledged the dates on resident #1?s October, November, and December 2019 MAR?s and resident #3?s December 2019 MAR were blank and did not include the initials of the direct care staff.
Plan of Correction:	1. Residents #1, 2 and 3?s MAR was reviewed by the nurse manager/designee. The resident?s representative and physician were notified of the missed documentation of administration by the Unit Manager/designee. 2. A 100% audit will be completed of the current month of all residents? MAR for missed documentation by unit managers/designees. All findings will be corrected and reported to the QA Committee for continued improvement and analysis. 3. Education regarding medication administration and record keeping provided to the nursing staff by the nurse managers. Facility educator will conduct at least 3 medication administration observation monthly. 4. The process be reviewed by the Administrator/designee monthly for 3 months by an audit of the medication observation to ensure compliance. . All findings will be corrected and reported to the QA Committee for continued improvement and analysis.