VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Runk & Pratt of Forest
208 Gristmill Drive
Forest, VA 24551
(434) 385-0297

Current Inspector: Jennifer Stokes (540) 589-5216

Inspection Date: Feb. 28, 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 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS Article 1 Subjectivity 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 SANCTIONS.

Technical Assistance:

350 B, 380 A, 450 D

Comments:

The LI for Runk and Pratt Forest, along with two other LI's, conducted an unannounced renewal study on 02/28/2020 from 9:30AM until 1:25PM, finding 60 residents in care. The inspection included a tour of the physical plant, observation of a medication pass, review of the medication storage carts and observation of the midday meal to see if special diets are being given as required by physicians' orders. Eight resident records were thoroughly reviewed and an additional six were partially reviewed in relation to the observation of the medication pass. Sworn disclosures statements and criminal record checks were examined for all newly hired staff and the records of four staff were thoroughly reviewed. Additional facility documentation was surveyed for compliance with the Standards for Assisted Living Facilities. Findings were reviewed with facility staff during the inspection. An exit interview was conducted with the Director of Nursing and an Administrator from a sister facility on the date of the 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 #:	22VAC40-73-325-A
Description:	Based on a review of resident records, the facility failed to ensure that a fall risk rating was completed for assisted living level of care residents at the time their comprehensive plan of care is completed. EVIDENCE: 1. The record for resident 6, admitted to the facility on 1/23/2020, has a comprehensive plan of care completed on 1/23/2020 but a fall risk rating was not completed as of the day of inspection.
Plan of Correction:	Resident #6 fall risk completed day of inspection. DON/designee will perform chart audits randomly to ensure fall risk management documents are completed and present in resident records.
Standard #:	22VAC40-73-450-C
Description:	Based on resident record review, the facility failed to ensure that the Individualized Service Plan (ISP) addressed all of the identified needs. EVIDENCE: 1. The record for resident 1 contained an ISP, dated 08/15/2019, that stated the resident?s behavior is Abusive, Aggressive, and Disruptive greater than weekly. The uniform assessment instrument (UAI), dated 08/15/2019, for resident 1 stated that the resident is Abusive, Aggressive, and Disruptive less than weekly. After interviewing staff 5, it was determined that the ISP was incorrect and did not reflect the resident?s needs from the UAI. 2. The UAI, dated 08/12/2019, for resident 3 stated that resident needs mechanical and physical human assistance with bathing. The ISP, dated 08/12/2019, for resident 3 stated that resident needs ?mechanical and supervision; staff will supervise resident in adjusting water and getting in/out the shower for safety, along with use mechanical device (grab bars/bench seat)?. Interview with staff 5 revealed that resident 3 does need physical human assistance with bathing.
Plan of Correction:	Resident #1 & Resident #3 ISP & UAI updated day of inspection to reflect the accurate needs of the resident. DON/Administrator will review UAI/ISP monthly to ensure accuracy of resident?s needs are reflected.
Standard #:	22VAC40-73-550-F
Description:	Based on tour of the physical plant, the facility failed to ensure that the rights and responsibilities of residents were posted conspicuously in a public place EVIDENCE: 1. There was a stapled packet of rights and responsibilities with only the first page visible located inside of a locked glass cabinet on the wall located in the lobby of the facility.
Plan of Correction:	Cabinet unlocked day of inspection. New wall cabinet will be installed by 3-27-2020 to ensure all of the information contained within is visible to public.
Standard #:	22VAC40-73-610-B
Description:	Based on tour of the physical plant, the facility failed to ensure the menu for meals and snacks for the current week was posted. EVIDENCE: 1. The menu posted in the main dining room for breakfast, lunch and supper and snacks was dated Sunday February 9, 2020 - Saturday February 15, 2020.
Plan of Correction:	Corrected day of inspection. Wall cabinet to be installed to display monthly menu. Dietary supervisor educated on process of posting monthly menu and making necessary changes throughout the month.
Standard #:	22VAC40-73-640-A
Description:	Based on observations of the facility medication carts, the facility failed to implement their medication management policy in regards to methods to prevent the use of outdated medications. EVIDENCE: 1. A Levemir Flex Touch Insulin Pen and a bottle of Latanoprost 0.0005% eye drops were noted to be opened in the cart for resident 15. Neither medication was labeled with the dates they were opened to ensure that they are discarded within 42 days of opening per manufacturer?s instructions. 2. A bottle of Latanoprost 0.0005% eye drops was noted to be opened in the cart for resident 16. The medication was not labeled with the date it was opened to ensure that it is discarded within 42 days of opening per manufacturer?s instructions. 3. A bottle of Combigan eye drops was noted to be opened in the cart for resident 16. The medication was not labeled with the date it was opened to ensure that it is discarded within 4 weeks of opening per manufacturer?s instructions. 4. The facility medication management plan has documentation of ?check carts to ensure all medications are labeled properly (open dates)? as part of methods for monitoring medication administration and the effective use of the EMAR for documentation.
Plan of Correction:	Medications for resident #15 & #16 corrected with date opened or discarded on date of inspection. DON/designee will continue to enforce medication management to ensure all medication requiring opened date are labeled properly through audits.
Standard #:	22VAC40-73-650-A
Description:	Based on a review of resident records, the facility failed to ensure that medications were not stopped or changed with a valid order from a physician. EVIDENCE: 1. The February 2020 medication administration record (MAR) for resident 10 has documentation of the prescribed medication Humulin N Insulin being held on 2/1, 2/2, 2/3, 2/6, 2/8, 2/9, 2/10, 2/13, 2/14 and 2/15. The prescribed medication Humulin R Insulin has documentation of being held on 2/1, 2/2, 2/3, 2/4, 2/6, 2/8, 2/9, 2/10, 2/13, 2/14, 2/15, 2/19, 2/22, 2/26 and 2/27. Documentation of the MAR indicates that the medication was held due to the resident?s blood sugar being low/out of parameters. The record for resident 10 did not have physician orders for parameters to hold any of the residents insulin and the record did not contain any documentation that the residents physician was contacted each time the medications was held.
Plan of Correction:	DON/designee will educate all RMA?s on proper administration and documentation. RMA?s are to complete a review of MAR prior to end of shift to ensure medications have been administered as ordered and notified DON/designee if orders are needed to directly reflect resident?s need.
Standard #:	22VAC40-73-860-G
Description:	Based on tour of the physical plant, the facility failed to ensure that hot water taps available to residents shall be maintained within a range of 105 degrees Fahrenheit to 120 degrees Fahrenheit (F). EVIDENCE 1. The hot water taps in the following residents? rooms did not reach a temperature of 105F to 120F: room A6 registered at 98.6F and room A4 registered at 98.8. The hot water taps in the following residents? room exceeded a temperature of 105F to 120F: room C2 registered at 121.9F and room C5 registered at 123F.
Plan of Correction:	Water temperature tested and corrected by facility maintenance. Maintenance will monitor water temperature randomly throughout facility on quarterly basis to address in malfunctions.
Standard #:	22VAC40-80-120-E-2
Description:	Based on tour of the physical plant, the facility failed to ensure that the findings of the most recent inspection of the facility was posted. EVIDENCE: 1. There was a stapled packet of the most recent inspection of the facility with only the first page visible located inside of a locked glass cabinet on the wall located in the lobby of the facility.
Plan of Correction:	Cabinet unlocked day of inspection. New wall cabinet will be installed by 3-27-2020 to ensure all of the information contained within is visible to public.