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. 31, 2020

Complaint Related: No

Areas Reviewed:

22VAC40-73 STAFFING AND SUPERVISION 22VAC40-73 BUILDING AND GROUNDS

Comments:

An unannounced focused monitoring inspection was conducted on 01-31-2020 from 10:42 AM to 2:39 PM. There were 124 residents in care at the time of the inspection. A tour of the "Evergreen" special care unit was conducted. Resident and staff records, facility policies, and the staff communication log were reviewed. The facility received violations "under" Staffing and Supervision and Buildings and Grounds. 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 #:	22VAC40-73-300-B
Description:	Based on record review and interview, the facility failed to utilize a method of communication as a means to keep direct care staff on all shifts informed of significant happenings experienced by residents to include incidents or injuries related to physical conditions. Evidence: 1. Staff #3 provided a copy of the facility?s policy titled ?Guidelines for resident?s accident/incident reports.? The policy documented ?The following will be used to initiate an Accident/Incident Report: ? any unexplained bruise or contusion? All Accident/Incident Reports are to be filled out promptly and accurately. 2. Staff #3 provided an incident report on 01-28-2020 which documented ?On 01/20/2020 approximately 0745 AM Nurse Manager received a call from [family], POA for the above stated resident. [POA] voiced concern in regards to bruising that she noticed on [resident?s] lower back and buttocks. Three areas on the back approximately 1 to 2 inches apart. The discolorations are about larger than the size of a quarter? Staff 1 states that she did see the discolorations two days prior and assumed that the medication aide had performed the necessary paperwork for notification to the POA? Staff 2 states that she remembers her coworkers notifying her of the discolorations but failed to document immediately...? 3. During resident #1?s record review with staff #3, the ?PAL Notes? and the Evergreen ?24 Hour Report? dated 01-18-2020 did not include documentation that staff #1 or staff #2 informed the direct care staff on all shifts of resident #1?s discolorations until after it was brought to staff?s attention from the POA ?2 days? later. 4. Staff #3 acknowledged staff #1 and staff #2 did not complete an incident report promptly when resident #1?s discolorations were seen by staff, and acknowledged staff did not keep direct care staff on all shifts informed of resident #1?s discolorations.
Plan of Correction:	1. The facility completed when first discovered on 1/20/2020 prior to the inspection. An investigation was completed. Staff #1 and Staff #2 were re-educated immediately on the company policy and procedure for AL and a Special Care Unit. 2. All staff will be oriented by the educator/designee on the proper documentation and notification requirements for all residents on a Special Care Unit. 3. The Clinical Educator will provide training during orientation and annually to ensure that all staff know the proper procedure when reporting incidents occurring in a timely manner. Skin checks will be completed twice weekly or as needed when residents on Evergreen receive bathing care. 4. A monthly audit will be conducted by the unit manager or designee to ensure that weekly skin checks are being completed within compliance. The Unit Manager/designee will conduct one skin check each week to ensure that all CNA documentation is accurate and to monitor any undocumented skin integrity issues. All findings will be corrected and reported to the QA Committee for continued improvement and analysis.
Standard #:	22VAC40-73-860-I
Description:	Based on observation and interview, the facility failed to store cleaning supplies in a locked area. Evidence: 1. At approximately 1:56 PM with staff #3 present, a cleaning cart was observed on the ?Evergreen? special care unit located near the activity area. The cleaning cart was not stored in a locked area and was left unattended. The following cleaning supplies were observed on top of the cart: ?Clorox? wipes, ?Suprox-D?, ?Bowl Cleaner?, and ?Tropic Breeze? air freshener. 2. Staff #3 acknowledged that the aforementioned cleaning supplies were not stored in a locked area.
Plan of Correction:	1. The Administrator Immediately removed the housekeeping cart from an unsafe environment. Staff #3 was educated immediately on the importance of keeping the environment in a special care unit safe and free of chemicals that could be hazardous to the residents due to cognition. 2. The Clinical Educator and the Environmental Services Director will ensure that EVS department is provided with training on Dementia and the responsibilities of staff on a special care unit. 3. Education regarding Special Care Unit safety will be provided to all staff quarterly by the Nurse Educator. The EVS Director/designee will conduct at least 4 documented checks weekly to ensure that all staff are following the appropriate procedures. 4. The process be reviewed by the Administrator/designee monthly for 3 months. The Administrator will perform an audit to ensure that all housekeeping carts are locked and keep appropriately. All findings will be corrected and reported to the QA Committee for continued improvement and analysis.
Standard #:	22VAC40-73-870-E
Description:	Based on record review and interview, the facility failed to ensure all toilets are kept in good repair. Evidence: 1. On 01-28-2020, staff #3 provided an incident report which documented resident #1 had a loose toilet seat. 2. A review of the maintenance work order documented the family requested for resident #1?s toilet seat to be tightened on 01-13-2020 and on 01-24-2020 the seat was tightened. 3. During interview, staff #3 acknowledged resident #1?s toilet seat was not in good in good repair.
Plan of Correction:	1. Resident #1?s toilet seat has been fixed. All staff will be educated by the Administrator/designee on the importance of ensure that all residents are safe all equipment used by the resident is in good repair. 2. Training will be provided during orientation on the importance of the reporting and the follow up on any equipment within the community that is not in good repair. Training will be provided by the Maintenance Director and/or designee. 3. The Clinical Educator will provide training during orientation to ensure that all staff know the proper procedure when reporting incidents occurring in a timely manner. 4. An audit of 5 residents with incidents will be reviewed for 6 weeks by the administrator to ensure proper documentation and proper notification given to the appropriate parties. All findings will be corrected and reported to the QA Committee for continued improvement and analysis.