VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Willow Estates Retirement, Inc.
180 Titus Drive
Penn laird, VA 22846
(540) 908-0723

Current Inspector: Jeffrey Marnien (540) 571-0189

Inspection Date: Feb. 18, 2020

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-73 BUILDING AND GROUNDS

Technical Assistance:

Discussed that the previous treatment provided by the exterminator has failed and needs to be addressed immediately - all areas should be reviewed and not simply one location. Procedures were implemented during the inspection to curtail spread. It was further discussed that the resident could not be held responsible for losses during the process unless it was determined that said individual created the problem initially which was not and is not the case.

Comments:

This inspection was in response to a complaint related to water temperatures, building , inconsistent activities and medication administration. The building appeared clean during the inspection with the exception noted of the need for an exterminator identified while this inspector was in the building. Water temperatures were higher than allowed by the standards but were definitely below what had been measured in the past. Residents and families continue to express issues related to activities or the lack of variation in activities as noted in the violation. Multiple issues were identified related to medication administration, also a previous violation, making that portion of the complaint valid. Thank you to residents, families and staff for your cooperation during this complaint inspection process. If you should have additional questions or concerns please call (540) 332-2330 or e-mail this inspector at sharon.deboever@dss.virginia.gov.

Violations:

Standard #:	22VAC40-73-520-A
Complaint related:	Yes
Description:	Residents and families continue to voice concerns related to the lack of activities. The schedule indicates the required hours however the variety required is lacking and activities do not always occur as noted on the schedule. Physical activities are almost non-existent and for those individuals who can not readily participant there is not a schedule of one-on-one activities for them.
Plan of Correction:	The facility has an activities person and the administrator will discuss with them additional training and assist with developing more variation. Staff will also receive training related to assisting with activities. The administrator assumes responsibility for correction and future compliance.
Standard #:	22VAC40-73-680-D
Complaint related:	Yes
Description:	Based on a review of a random selection of medication administration records(MAR), medications were not administered in accordance with physician orders or consistent with standards of practice outlined in the current medication aide curriculum approved by the Virginia Board of Nursing. Resident A: Blanks on the MAR with no indication if medication was or was not given - this included insulin. When insulin was administered it was not consistently administered as per the sliding scale ordered by the physician. Resident B: Received 11 does of "as needed" tramadol for pain with with documentation related to need and effectiveness for only two doses. Resident C: Blood glucose levels were not consistently documented three times a day as per physician order. Resident I: Order states to apply ointment to a stage II wound twice daily which is out of the scope of practice of a medication aide. Additionally would measurements have to be provided weekly to the licensing office for any wound stage II or greater,
Plan of Correction:	The nurse and administrator, who is also a nurse, assume responsibility for correction and future monitoring and compliance. Medication administration records will be reviewed a minimum of weekly by one or the other or both. Staff will receive additional training related to insulin administration, documentation and scope of practice. Home health will be contacted to provide services to resident I as long as stage II wound.
Standard #:	22VAC40-73-680-I
Complaint related:	Yes
Description:	Based on a random selection of medication administration records (MAR) the physician's order on the MAR did not consistently contain a diagnosis for the medication. One order contained a range for administration (1-2 tablets). Resident E and I had two orders for diagnosis with no distinction how each should be used. There were no parameters when to hold insulin or contact physician as it related to blood glucose levels. Resident B has an order Tylenol noting not to exceed 3gm in 24 hours but nothing to indicate how a medication aide calculates that, Resident D has an order to "wash inflammatory skin" with no indication where that is and further notes to use a blow dryer if necessary to dry thoroughly which has been noted to be dangerous, especially without specific training.
Plan of Correction:	Orders will be reviewed by the facility nurse and diagnosis obtained and additional corrections and forwarded to the pharmacy to be included on the MAR. The nurse in conjunction with the administrator assume responsibility for correction and future compliance.
Standard #:	22VAC40-73-860-G
Complaint related:	Yes
Description:	Hot water temperatures in one area of the building continue to exceed 120 degrees Fahrenheit, ranging from 129 degrees to 132 degrees. This is a decrease in temperatures from previous measurements of the same area. Interviews indicated that they prefer warmer temperatures and others noted it was "a little too hot".
Plan of Correction:	The plumber was contacted during the inspection process and the temperatures were scheduled to be addressed during the week. The administrator will follow up with the plumber to ensure correction. Weekly water temperatures will be taken specifically in the area of concern and if issues should arise again the plumber will be brought in.