VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Arden Courts (Annandale)
7104 Braddock Road
Annandale, VA 22003
(703) 256-0882

Current Inspector: Jacquelyn Kabiri (703) 397-3017

Inspection Date: Jan. 16, 2020 , Jan. 23, 2020 and Feb. 25, 2020

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 RESIDENT CARE AND RELATED SERVICES

Comments:

Unannounced complaint inspections were conducted on 1/16/20, 1/23/20, and 2/25/20 in response to a complaint received by the licensing office on 1/5/20 regarding medication administration. Medication administration was observed, documents were reviewed, and interviews were conducted. Violations were discussed and an exit meeting was held. The complaint was determined to be "valid," as a preponderance of evidence supported the allegation. Areas of non-compliance are identified on the violation notice. Please complete the 'plan of correction' and 'date to be corrected' for each violation cited on the violation notice and return to the licensing office within 10 calendar days. Please specify how the deficient practice will be or has been corrected. Just writing the word 'corrected' is not acceptable. The 'plan of correction' must contain: 1) Steps to correct the non-compliance with the standards, 2) Measures to prevent the non-compliance from occurring again, and 3) Person responsible for implementing each step and/or monitoring any preventative measures. Thank you for your cooperation and if you have any questions, please contact me via e-mail at m.massenberg@dss.virginia.gov.

Violations:

Standard #:	22VAC40-73-640-A
Complaint related:	Yes
Description:	Based on documentation and interview, the facility failed to implement the medication management plan. Evidence: The facility's medication management plan calls for medications to be re-ordered by a licensed nurse when a five-day supply remains. Evidence: Resident #1's medication administration record (MAR) states that the resident's Lisinopril was not administered 1/5/20 - 1/7/20, as the medication was not available/pending delivery. The MAR calls for Resident #1 to receive one tablet of Lisinopril 5mg daily. Resident #2's MAR states that the resident's Levetiracetam was not administered on 1/4/20 (6 AM administration), as the medication was not delivered. The MAR calls for Resident #2 to receive one tablet of Levetiracetam 500mg twice per day. Resident #3's MAR stated that the resident's Bupropion was not administered on 1/5/20, as the medication was not available. Resident #3's MAR stated that the resident's Olanzapine was not administered on 1/10/20, as the medication was not available. The MAR calls for Resident #3 to receive one tablet of Bupropion 150mg and one tablet of Olanzapine 2.5mg daily. The pharmacy was contacted to inquire about the timing of the re-order requests. The pharmacy reported that Resident #1's Lisinopril was re-ordered on 1/5/20. The pharmacy reported that Resident #2's Levetiracetam was re-ordered on 1/3/20. The pharmacy reported that Resident #3's Bupropion was re-ordered on 1/5/20, and that the resident's Olanzapine was re-ordered on 1/10/20.
Plan of Correction:	Deficiencies were based on a complaint received by the DSS licensing office on 01/05/2020 regarding medication administration. The investigation was conducted by the DSS Licensing Inspector on 01/16/2020 and 01/23/2020 and completed on 02/25/2020. RSC provided re-training on the appropriate implementation of the facility medication management plan and the timely ordering, reordering of prescribed medications on January 16,2020 and January 20, 2020. RSC and/or designee will conduct impromptu audits of the medications and MAR?s to ensure all medications are available as ordered. RSC and/or designee will provide training and/or retraining to LPN?s and MT?s on the appropriate implementation of the facility medication management plan and timely ordering/reordering of prescribed medications This training will be conducted and reviewed by the RSC and/or designee on orientation, annually and, as needed. RSC, Executive Director or designee will conduct impromptu audits of medication administration and MAR?s to ensure all medications are available as ordered. A qualified healthcare provider will audit MAR?s to ensure all prescribed medications are available during the quarterly healthcare oversight.
Standard #:	22VAC40-73-680-D
Complaint related:	Yes
Description:	Based on observation and documentation, the facility failed to ensure that medications are administered in accordance with the physician's instructions. Evidence: The morning medication administration for Resident #1 was observed during the inspection on 1/16/20. Resident #1's medications were placed into a pill cup for administration. Before the medication was placed in yogurt for administration, the licensing inspector inquired about the resident's Vitamin D. The medication cup contained only one 1000U gelcap of Vitamin D. Resident #1's Vitamin D order, dated 9/17/10, called for the resident to receive 2000U of Vitamin D during the medication administration. Resident #1's medication administration record (MAR) stated that the resident's Lisinopril, ordered 6/22/16, was not available to be given from 1/5/20 - 1/7/20. Resident #2's MAR stated that Levetiracetam (ordered 10/12/18 to treat myoclonic jerks) was not administered on 1/4/20 (6 AM administration). The MAR stated that the Levetiracetam was not delivered by the pharmacy on 1/4/20. Nursing notes stated that Resident #2 had a jerking/seizure episode at 6:30 AM. Later that afternoon, Resident #2 was taken to the hospital after she began choking. Hospital notes reported that Resident #2 had two episodes of seizures with tonic-clonic activity, while in the emergency room. Resident #3's MAR stated that the resident's Bupropion, ordered 10/22/19, was not available to be given on 1/5/20. The MAR stated that the resident's Olanzapine, ordered 10/30/19, was not available to be given on 1/10/20.
Plan of Correction:	Deficiencies were based on a complaint received by the DSS licensing office on 01/05/2020 regarding medication administration. The investigation was conducted by the DSS Licensing Inspector on 01/16/2020 and 01/23/2020 and completed on 02/25/2020. RSC provided re-training on the timely ordering, reordering and, administration of prescribed medications on January 16,2020 and January 20, 2020. RSC and/or designee will conduct impromptu audits of the medications and MAR?s to ensure all medications are available and administered as prescribed. RSC and/or designee will provide training and/or retraining to LPN?s and MT?s on the timely ordering/reordering and administration of prescribed medications This training will be conducted and reviewed by the RSC and/or designee on orientation, annually and, as needed. RSC, Executive Director or designee will conduct impromptu audits of medication administration and MAR?s to ensure all medications are available and administered as prescribed. A qualified healthcare provider will audit MAR?s to ensure all prescribed medications are available and administered during the quarterly healthcare oversight.