VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Indian River Assisted Living
1012 Justis Street
Chesapeake, VA 23325
(757) 523-4659

Current Inspector: Margaret T Pittman (757) 641-0984

Inspection Date: March 6, 2020

Complaint Related: No

Areas Reviewed:

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:

Two Licensing Representatives conducted an unannounced Renewal inspection on March 6, 2020 from 7:06 a.m. to 4:13 p.m. The Administrator and Director of Resident Care were present throughout the inspection. The following was discussed during inspection: Activity categories, Emergency food supply, Preliminary/Comprehensive Individualized Service Plans (ISPs), Resident admission requirements, Resident rights, Menu substitutions, Water temperatures, and Emergency Preparedness and Response. Please submit your ?plan of correction? and ?date to be corrected? for each violation cited on the violation notice and return it within 10 calendar days. The plan of correction must indicate how the violation will be or has been corrected. The plan of correction must include: 1. Step(s) to correct the noncompliance with the standard(s) 2. Measures to prevent reoccurrence 3. Person(s) responsible for implementing each step and/or monitoring any preventative measures.

Violations:

Standard #:	22VAC40-73-250-C
Description:	Based on record review and interview, the facility failed to ensure personal and social data to be maintained on staff and included in the staff record was an original criminal record report. Evidence: 1. Staff #1's date of hire was 10-10-19. Staff #1's record did not contain an original criminal record report. 2. Staff #4 observed and confirmed staff #1's record did not contain the original criminal record report as required.
Plan of Correction:	All information on personal and social data on all new staff to be collected and maintained in the staff record.
Standard #:	22VAC40-73-290-A
Description:	Based on record review and interview, the facility failed to maintain a written work schedule that includes the job classifications of all staff working each shift. Evidence: 1. During review of the Staff Work Schedules for the months of January, February, and March 2020, there was no indication of staffs' job classifications for the dietary, housekeeping, or nursing schedules. 2. Staff #4 acknowledged the written work schedules for the months reviewed did not include the job classifications of all staff working each shift.
Plan of Correction:	All departments will post a written work schedule indicating who is in charge. Schedule maintained for 2 years.
Standard #:	22VAC40-73-310-D
Description:	Based on record review and interview, the facility failed to ensure based upon review of the Uniform Assessment Instrument (UAI) prior to admission of a resident, the assisted living facility administrator provided written assurance to the resident that the facility has the appropriate license to meet his care needs at the times of admission. Copies of the written assurance shall be given to the legal representative and case manager, if any, and a copy signed by the resident or his legal representative shall be kept in the resident?s record. Evidence: 1. The following four out of four residents? records did not contain a copy of the written assurance: a. Resident #3 admitted 01-14-20, b. Resident #4 admitted 01-23-20, c. Resident #5 admitted 02-06-20, and d. Resident #6 admitted 11-02-19. 2. Staff #4 observed and confirmed the aforementioned records did not contain a copy of the written assurance.
Plan of Correction:	Written assurances will be given to the legal representative and case manager and kept in the resident's record at admission.
Standard #:	22VAC40-73-680-B
Description:	Based on observation, record review, and interview, the facility failed to ensure medications remained in the pharmacy issued container, with the prescription label or direction label attached, until administered to the resident. Evidence: 1. During the medication administration observation on 03-06-2020 at approximately 7:06 a.m., pre-poured medications for residents were observed on the medication carts for the East and South Halls. 2. The medications were pre-poured by staff #1. Staff #1 stated, ?I?m the only person passing medications this morning on all four carts?; however, the March 2020 Staff Work Schedule documented staff #3 was scheduled from 7:00 a.m. to 3:00 p.m., which staff #2 confirmed. 3. Resident #1 was observed being administered pre-poured medications that staff #1 stated were the following: Benztropine Mesylate 1 mg, Carbamazepine 200 mg, Omeprazole 20 mg, and Risperidone 3 mg. 4. Resident #2 was observed being administered pre-poured medications that staff #1 stated were the following: Amlodipine Besylate 10 mg, Aspirin 81 mg, Benztropine Mesylate 1 mg, Hydrochlorothiazide 25 mg, Lisinopril 20 mg, and Meloxicam 15 mg. 5. Staff #1, staff #2, and staff #4 acknowledged the medications did not remain in the pharmacy issued container, with the prescription label or direction label attached, until administered to the residents.
Plan of Correction:	All RMAs were in-serviced on 3/9/20 3/18/20 and 4/2/20 on medications shall remain in the pharmacy issued container, with the prescription label or direction label attached, until administered to the resident (NO meds to be "pre-poured")
Standard #:	22VAC40-73-830-E
Description:	Based on record review and interview, the facility failed to provide a written response to the council prior to the next meeting regarding any recommendations made by the council for resolution of problems or concerns. Evidence: 1. January and February 2020 ?Resident council notes? were reviewed on 03-06-2020; however, no written responses to the council were observed regarding any recommendations made by the council for resolution of problems or concerns. 2. Staff #4 acknowledged written responses to the council prior to the next meeting were not completed.
Plan of Correction:	IRAL will provide a written response to the council prior to the next meeting regarding any concerns raised and will post in the South Activity Room.
Standard #:	22VAC40-73-870-A
Description:	Based on observation and interview, the facility failed to ensure the interior of the building was maintained in good repair and kept clean. Evidence: 1. During a tour of the facility on 03-06-2020, the following was observed not to be maintained in good repair and/or kept clean: a. ?Living Room? contained dark brownish-black stains in three places in front of the brown sofa. Two of the stains were approximately one foot in length, and the third was approximately four inches in diameter. b. ?South Hall? Room 56 contained black scuff marks on the wall in the resident?s bedroom vertically approximately 5 inches long, and horizontally approximately 12 inches long. c. ?South Hall? and ?North Hall? contained holes in the wall where a telephone was missing. 2. Staff #4 observed and confirmed the aforementioned areas were not maintained in good repair and/or kept clean.
Plan of Correction:	Living room carpet cleaned 3/10/20. South Hall #56 cleaned and painted on 4/1/20. Holes in the South and North hallway wall by telephone repaired and patched on 3/6/20. Ongoing efforts to keep building clean and in good repair.
Standard #:	22VAC40-73-950-A
Description:	Based on record review and interview, the facility failed to ensure documentation of initial contact with the local emergency coordinator to determine (i) local disaster risks, (ii) communitywide plans to address different disasters and emergency situations, and (iii) assistance, if any, that the local emergency management office will provide to the facility in an emergency was addressed in the emergency preparedness and response plan. Evidence: 1. The facility?s emergency preparedness and response plan did not contain documentation of initial contact with the local emergency coordinator to determine (i) local disaster risks, (ii) communitywide plans to address different disasters and emergency situations, and (iii) assistance, if any, that the local emergency management office will provide to the facility in an emergency. 2. Staff #4 acknowledged contact with the local emergency coordinator had not been made as of the date of the inspection on 03-06-2020.
Plan of Correction:	Coordinating with the City of Chesapeake's Emergency Planning and Preparedness' Deputy Coordinator of Emergency Services to review written emergency preparedness and response plan.