VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Candis Assisted Living
1619 Hanover Ave
Roanoke, VA 24017
(540) 343-8640

Current Inspector: Angela Marie Swink (276) 623-6575

Inspection Date: Jan. 29, 2020

Complaint Related: No

Areas Reviewed:

22VAC40-73 GENERAL PROVISIONS 22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES 22VAC40-73 PERSONNEL 22VAC40-73 STAFFING AND SUPERVISION 22VAC40-73 ADMISSION, RETENTION, AND DISCHARGE OF RESIDENTS 22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-73 RESIDENT ACCOMODATIONS AND RELATED PROVISIONS 22VAC40-73 BUILDING AND GROUNDS 22VAC40-73 EMERGENCY PREPAREDNESS 63.2 General Provisions. 63.2 Protection of adults and reporting. 63.2 Licensure and Registration Procedures 63.2 Facilities and Programs.. 22VAC40-90 Background Checks for Assisted Living Facilities 22VAC40-90 The Sworn Statement or Affirmation 22VAC40-90 The Criminal History Record Report 22VAC40-80 THE LICENSE. 22VAC40-80 THE LICENSING PROCESS. 22VAC40-80 COMPLAINT INVESTIGATION. 22VAC40-80 SANCTIONS.

Comments:

The LI for Candis Adult Home, along with two other LIs, conducted an unannounced monitoring inspection on 01/29/2020 from 8:25AM until 4:15PM, finding 14 residents in care. The inspection included a tour of the physical plant, observation of three medication passes and resident interviews. Six resident records were thoroughly reviewed. Sworn disclosure statements and criminal record checks were examined for all newly hired staff, and the records of three staff were thoroughly examined. Findings were reviewed with the facility staff during the inspection. An exit interview was conducted with the owner of the facility on the date of inspection, where findings were reviewed and an opportunity was given for questions, as well as for providing any information or documentation which was not available during the inspection. Please complete the ?plan of correction? and ?date to be corrected? for each violation cited on the violation notice and return it to your licensing inspector within 10 calendar days from today. You will need to specify how the deficient practice will be or has been corrected. Just writing the word ?corrected? is not acceptable. Your plan of correction must contain: 1) steps to correct the noncompliance with the standard(s), 2) measures to prevent the noncompliance from occurring again; and 3) person(s) responsible for implementing each step and/or monitoring any preventive measure(s). If you have any questions, contact your licensing inspector at (540) 589-5216..

Violations:

Standard #:	22VAC40-73-250-D
Description:	Based on review of staff records, the facility failed to obtain TB screenings on new staff on or within seven days prior to the first day of work at the facility, and no older than 30 days prior to beginning work. EVIDENCE: 1. Staff 3 began work on 1/28/2020 and the TB assessment is dated 11/15/2019. 2. Staff 4 began work on 12/6/2019 and the TB assessment is dated 10/15/2019.
Plan of Correction:	Administrator prior to hiring/training will ensure that applicant has a recent TB screening to obtain one within 7 days prior to working and TB older than 30 days prior to beginning work. Facility nurse will perform TB screening on all new hires if they new hire does not have a recent TB screening prior to beginning work. TB evaluation obtained/performed by facility nurse.
Standard #:	22VAC40-73-270-1
Description:	Based on interviews and review of staff and resident records, the facility failed to ensure new staff had training in methods of dealing with agitated or aggressive residents, prior to being involved in the care of such residents. EVIDENCE: 1. Staff 3 started work on 1/28/2020, and stated that she was supposed to get her training in methods of dealing with agitated or aggressive residents tomorrow (1/30/2020). The uniform assessment instrument (UAI) dated 2/19/20129 for resident 6 shows this resident is abusive/aggressive/disruptive weekly or more. Staff 3 was working with residents at various times of the day, and this was confirmed by staff interviews.
Plan of Correction:	Staff 3 had just been hired and in orientation training and had aggressive training on here and had additional training scheduled 01/30/2020. All staff who work with residents are properly trained in aggressive behavior according to state regulations.
Standard #:	22VAC40-73-320-B
Description:	Based on record review, the facility failed to ensure that tuberculosis testing was completed annually for residents. EVIDENCE: 1. The record for resident 3 contained the most recent TB screening which was dated 11/13/2018.
Plan of Correction:	Resident had chest x-ray physical on 2019 and TB screening. Resident's chart had been thinned and physical and TB had been filed. Physical and chest x-ray placed back on resident's file/chart.
Standard #:	22VAC40-73-440-A
Description:	Based on resident record review and staff interview, the facility failed to ensure that the Uniform Assessment Instrument (UAI) was completed as required and that a resident was assessed in accordance with Assessment in Assisted Living Facilities (22VAC30-110). EVIDENCE: 1. The most recent UAI, dated 11/27/2019, for resident 3 did not address Eating/Feeding needs. 2. The individualized service plan (ISP) for resident 4 states that the resident uses a rollater walker to help prevent falls daily at the facility and out of facility, staff to stand by assist going up and down stairs (upstairs) ?per resident request?. The public pay UAI for resident 4 dated 11/18/2019 states that resident 4 does not need help with walking or stairclimbing. Interview with staff 1 verified that resident 4 does request mechanical assistance with walking and mechanical and human assistance with stairclimbing. There is no documentation that the facility has contacted local adult protective services (APS) to conduct a new UAI assessment on the resident. 3. Resident 2, admitted on 12/12/2019, had a public pay uniform assessment instrument (UAI) dated 11/8/2019. When questioned about numerous discrepancies between the UAI and the individualized service plan (ISP), staff 1 stated that resident 2 is private pay, the public ay UAI is incorrect, and that she did a private pay UAI at the time of admission. The private pay UAI was not in the record and could not be located. 4. The private pay UAI for resident 6, dated 2/19/2019, shows the resident needs mechanical and human help with physical assistance when using stairs. The ISP shows that resident 6 needs mechanical help only. Staff interview confirms that the ISP is correct, and the UAI assessment is incorrect.
Plan of Correction:	Boxes were left unchecked. These were corrected day of inspection. Charge nurse will review UAIs weekly. Administrator will review monthly. APS social worker was contacted and corrected. UAI was sent and placed on resident's chart. A private pay UAI was done at time of admission. The UAI was located day of inspection and placed in the resident's chart. Charge nurse will review charts weekly. Administrator will review charts monthly. Administrator will recheck all UAIs and ISPs when they are completed.
Standard #:	22VAC40-73-450-C
Description:	Based on record review, the facility failed to ensure that the Individualized Service Plan (ISP) addressed all of the identified needs. EVIDENCE: 1. The UAI, dated 4/7/2019, assessed resident 3 as needing mechanical help with mobility needs; however, this is not addressed on the ISP.
Plan of Correction:	Mechanical help with mobility was added to the ISP. Administrator will check UAIs and ISPs monthly and review.
Standard #:	22VAC40-73-640-A
Description:	Based on record review, the facility failed to implement a medication management policy that addressed all required components. EVIDENCE: 1. The January 2020 MAR for resident 6 included PRN Benzonatate 100 MG capsule, which was discontined 07/26/2017. 2. The facility?s current medication management plan states that controlled drugs must be counted before and after each shift, and any narcotics given or wasted accounted for. There is a Narcotics sign out book (black binder) that should be counted and signed off any time you give a controlled drug (narcotic). The med tech going off and the med tech coming on should count that controlled drugs together to verify that the count is accurate, and both initial on the date and shift. The ?CERTIFICATION OF CONTROLLED DRUG BALANCES? log was missing signatures for the following dates/times: 12/23/2019; 3PM-11PM off shift, 01/10/2020; 7AM-3PM off shift, 01/15/2020; 3PM-11PM off shift, 01/17/2020; 3PM-11PM off shift, and 01/19/2020; 7AM-3PM off shift. 3. The MAR for resident 1 stated that resident has AYR Nasal Mist #50 0.65% Spray and Robafen 100 MG/5ML Liquid prescribed as needed (PRN). During cart audit, these two medications were not able to be located by the medication aide on duty. 4. The facility?s current medication management policy states ?do not give any `expired? medications?. During medication cart audit, there was an opened container of Lantanoprost 0.5% eye drops for resident 7. The eye drops are good for 6 weeks after being opened. There was no date written on the box of when the eye drops were opened. 5. The facility's current medication management policy does not include methods to ensure an understanding of the responsibilities associated with medication management, to ensure that residents do not receive medications or dietary supplements to which they have known allergies, identification of the medication aide or the person licensed to administer drugs, methods to ensure that staff who are responsible for administering medications are trained on the facility's medication management plan and procedures for internal monitoring of the facility's conformance to the medication management plan.
Plan of Correction:	Medication was removed from the cart. Charge nurse will audit carts weekly for any discontinued medications. All licensed/registered staff were counseled from Administrator and owner. Staff meeting held. Narcotic sign count shift book was corrected. Each employee prior to exiting the building will be required to double check their work. Medication was ordered from pharmacy and placed in cart. Licensed nurse, registered medication aides will audit carts weekly. Eye drops taken from cart and properly discarded and replaced with new eye drops. Charge nurse to audit med cart weekly. Medication management plan does address allergies to ensure residents do not receive medications or food to which they have known allergies. Policy and procedures given in training which includes med management plan. Allergies are included in med mgt. plan.
Standard #:	22VAC40-73-650-A
Description:	Based on review of resident record, the facility failed to ensure that the resident?s medication was not changed by the facility without a valid order from a physician or other prescriber. EVIDENCE: 1. Physician?s order for resident 3 showed Olanzapine 5MG to be taken at bedtime. The January 2020 medication administration record (MAR) for resident 3 showed Olanzapine 5MG as scheduled for and given at 8AM.
Plan of Correction:	Pharmacy for our facility enters all new medication orders. Pharmacy notified and was corrected in EMAR system. Charge nurse will review EMARs weekly for any discrepancies.
Standard #:	22VAC40-73-660-A
Description:	Based on observation, the facility failed to ensure that dedicated medical supplies were labeled with the resident?s name. EVIDENCE: 1. While performing the medication cart audit, the glucometer machines for resident 1 and resident 6 were not labeled.
Plan of Correction:	The glucometer machines had been labeled and had fallen off. Charge nurse will check daily to ensure properly labeled. The glucometers were corrected day of inspection.
Standard #:	22VAC40-73-680-B
Description:	Based on audit of the main medication cart, the facility failed to ensure that medications remained in the pharmacy issued container, with the prescription label or direction label attached, until administered to the resident. EVIDENCE: 1. During audit of the main medication cart, there was a loose small round orange pill with ?20? on one side and ?LUPIN? on the other side located in the second drawer.
Plan of Correction:	Pill was properly discarded. Charge nurse will check daily all medications in med cart to ensure all medications remain in pharmacy issued container. Administrator will check med cart weekly.
Standard #:	22VAC40-73-680-I
Description:	Based on record review, the facility failed to ensure that the medication administration record (MAR) contained all required elements. EVIDENCE: 1. The January 2020 MAR for resident 6 did not include the diagnosis, condition, or specific instructions for administering drugs or supplements for the following medications: Atorvastatin, Ferrous Sulfate, Olanzapine, Cyclobenzaprine, and Deep sea spray. 2. The MAR for resident 6 did not include the date, time given and initials of staff administering the following medications on 01/16/2020: scheduled 12PM dose of Refresh Tears and Combivent, and the scheduled 2PM dose of Olanzapine and Hydralazine. 3. The MAR for resident 1 did not include the date, time given and initials of staff administering the following medications on 01/13/2020: Scheduled 4PM does of Tamsulosin HCL. 4. The MAR for resident 3 did not include the date, time given and initials of staff administering the following medications on 01/17/2020: Scheduled 9PM dose of Diclofenac Sodium and did not include the date, time given and initials of staff administering the following medications on 01/21/2020: scheduled 4PM dose of Symbicort.
Plan of Correction:	MARS will be reviewed daily and every month. Physician office will be notified by charge nurse for information or discrepancies obtained and sent to pharmacy. The medications were given and the charge nurse went in EMAR and corrected on day of inspection. Charge nurse will review each daily. The medications were given and LPNs and RMAs will review daily. Medication was given. Corrected by RMA. Employee will be required to check their work and EMAR and review weekly.