VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Bell's Residential Adult Care Home
3720 Deep Creek Boulevard
Portsmouth, VA 23702
(757) 397-5586

Current Inspector: Donesia Peoples (757) 353-0430

Inspection Date: March 3, 2020

Complaint Related: No

Areas Reviewed:

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

Comments:

An unannounced mandated monitoring inspection was conducted on 03-03-2020 from 7:30 AM to 1:32 PM. There were 26 residents in care at the time of the inspection. A tour of the facility was conducted, water temperatures were sampled, and the emergency food and water supply was reviewed. 3 residents were observed during the medication pass observation. The medication cart was reviewed. An activity was conducted and breakfast was observed. The following was reviewed: resident records and staff records, criminal background checks and sworn disclosures on new staff hired since the previous inspection, the First Aid kit, emergency preparedness review, resident emergency exercise and fire drills, the dietary and health care oversights, menus, activity calendars, and staff schedules. The facility does not currently have a resident council. The following was discussed with the Administrator and Medication Aide: ordinary objects that could be viewed as a restraint, ISPs, Licensing Administrator information on the resident rights, Written Assurance regarding the UAI, snacks, visitation, and the fire evacuation map. The facility received violations "under" Staffing and Supervision, Admission, Retention, and Discharge of Residents, and Resident Care and Related Services. The areas on noncompliance were reviewed with the Administrator and Medication Aide throughout the inspection and during the exit interview. 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, on 03-19-2020.

Violations:

Standard #:	22VAC40-73-290-A
Description:	Based on record review and interview, the facility failed to maintain a written work schedule that included any changes to the schedule. Evidence: 1. The Licensing Inspector requested a copy of the January and February 2020 written work schedules. Staff #1 provided a copy of the January 2020 weekly schedules for the weeks of 01-05-2020 through 01-18-2020; however staff #1 could not locate and/or provide the schedules for 01-01-2020 through 01-04-2020, or 01-19-2020 through 01-31-2020. 2. The February 2020 weekly written work schedules documented: A. 1 direct care staff (staff #2) was scheduled to work during the 11:00 P.M to 7:00 A.M. shift on 02-20-2020, 02-27-2020, and 02-29-2020; and staff #1 was listed as "off duty;" however, the "nightly log" sheets documented staff #1 worked on the aforementioned dates during the 11:00 P.M. to 7:00 A.M. shift. B. 1 direct care staff (staff #1) was scheduled to work during the 11:00 P.M to 7:00 A.M. shift on 02-21-2020, 02-24-2020, and 02-26-2020; and staff #2 was listed as "off duty;" however, the "nightly log" sheets documented staff #2 worked on the aforementioned dates during the 11:00 P.M. to 7:00 A.M. shift. C. The aforementioned dates on the February 2020 weekly written work schedules were not updated to reflect the changes on the schedules. 3. During interview, staff #1 acknowledged the facility did not have the January 2020 weekly staff written work schedules for 01-01-2020 through 01-04-2020, or 01-19-2020 through 01-31-2020; and acknowledged the February 2020 weekly written work schedules did not include the changes on the schedule.
Plan of Correction:	The facility administrator or designee will ensure all written work schedules are maintained and reflect changes. Changes to the schedule will be updated immediately as known.
Standard #:	22VAC40-73-350-B
Description:	Based on record review and interview, the facility failed to ascertain, prior to admission, whether a potential resident is a registered sex offender. Evidence: 1. Resident #6 admitted to the facility on 06-20-2019; however, the sex offender screening was dated 06-25-2019. 2. Staff #1 acknowledged the facility did not ascertain resident #6's sex offender screening prior to admission.
Plan of Correction:	The facility administrator or designee will review all prospective residents? information five days prior to admission to ensure completeness of all information required.
Standard #:	22VAC40-73-470-F
Description:	Based on record review and interview, the facility failed to ensure when the resident suffers a medical condition, or there is reason to suspect that such has occurred, medical attention from a licensed health care professional is secured immediately. The resident's physician, if not already involved, should be notified as soon as possible but no later than 24 hours from the situation and action taken. Evidence: 1. During resident #4's record review with staff #1, the "Discharge Notification and Statement" dated 10-23-2019 documented the resident was taken to the hospital on 10-19-2019 due to complaint of constipation; and was admitted and diagnosed with a blockage. 2. A letter from the facility to the hospital dated 10-19-2019 documented resident #4 is being sent to the emergency department for exhibiting the following symptoms: A. Wednesday, October 16, 2019 8:30 p.m. Complaint of constipation. 5 oz. prune juice given. Continued to complain of constipation. B. Thursday, October 17, 2019 8:45 a.m. - Prune juice given. Vomited all immediately. Tylenol given for complaint of stomach ache. C. Thursday, October 17, 2019 - Poor appetite; Light vomit. D. Friday, October 18, 2019- Poor appetite; Light vomit at bedtime. E. Saturday, October 19, 2019 8:45 a.m.- Drank 5 oz. water and vomited all immediately. 3. Staff #1 could not locate and/or provide documentation on file verifying staff notified the resident's physician of the resident's symptoms within 24 hours. 4. Staff #1 stated "the physician was not contacted" regarding resident #4's symptoms. Staff #1 acknowledged the facility did not secure medication attention immediately from a licensed health care professional and acknowledged the physician was not notified of the resident's symptoms within 24 hours.
Plan of Correction:	The facility administrator or designee will immediately notify a licensed health care professional of the occurrence of a medical condition a resident is experiencing within 24 hours. Documentation of the notification will be placed in the resident?s chart.
Standard #:	22VAC40-73-950-E
Description:	Based on record review and interview, the facility failed to implement a semi-annual review on the emergency preparedness and response plan with all residents. The review should be documented by signing and dating. Evidence: 1. Staff #1 provided a copy of the facility?s most current emergency preparedness and response plan dated 01-28-2020; however, per staff #1, the plan was reviewed with staff only and was not reviewed with all residents. 2. Staff #1 could not locate and/or provide documentation on file to verify all residents reviewed the facility?s emergency preparedness and response plan. 3. Staff #1 acknowledged the emergency preparedness and response plan was not reviewed with all residents.
Plan of Correction:	The facility administrator or designee will include all residents in the semi-annual review of the emergency preparedness and response plan. Documentation of the date and the residents? signatures will be obtained.