VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Commonwealth Senior Living at King's Grant House
440 North Lynnhaven Road
Va. beach, VA 23452
(757) 431-8825

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

Inspection Date: March 11, 2020

Complaint Related: No

Areas Reviewed:

22VAC40-73 STAFFING AND SUPERVISION 22VAC40-73 ADMISSION, RETENTION, AND DISCHARGE OF RESIDENTS 22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-73 BUILDING AND GROUNDS 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS Article 1 Subjectivity

Comments:

A focused unannounced monitoring inspection was conducted on 03/11/2020 from 8:30 AM to 6:14 PM. There were 69 residents in care at the time of the inspection. A tour of the facility was conducted. The following was reviewed during the inspection: resident records, staff schedules, and time sheets. The facility received violations "under" Resident Care and Related Services and Buildings and Grounds. The following was discussed with the Assistant Resident Care Director throughout the inspection and during the exit interview: Staff schedules, Ensuring new ISP system is compliant with the standards; ISP/UAI?s; storage of maintenance equipment/supplies; ensuring physician?s orders received when residents returns from medical appointments; and information on physician's orders regarding where to apply creams/ointments. The Administrator and RCD were not present during the inspection, however, they were present during the exit interview. The areas of noncompliance were discussed with the Administrator, RCD, and ARCD. 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 04-23-2020.

Violations:

Standard #:	22VAC40-73-650-A
Description:	Based on record review and interview, the facility failed to ensure that medication is not discontinued without a valid order from a physician. Evidence: 1. During resident #1?s record review with staff #1, the signed physician?s order on file dated 05-28-2019 contained the following ?Vitamin D2 Cap 50,000U- 1 capsule by mouth one time a day every seven days with food.? 2. In reviewing the Medication Administration Record for resident #1, there was no documentation indicating that the resident was administered the Vitamin D2 during the months of January and February 2020. 3. Staff #1 could not locate or provide a discontinued physicians order for the Vitamin D2. 4. Staff #1 acknowledged that the facility discontinued resident #1?s Vitamin D2 without a valid physician?s order.
Plan of Correction:	Resident #1 received a signed discontinue order from the physician for the Vitamin D2 50,000U capsule. All nurses and RMAs were re-in-serviced on Policy Med-12 Verification of Medication Orders and MED-17 Permanent Discontinuance. Resident Care Director or designee will conduct a Chart/Physician order audit minimum of 13 charts per month to ensure ongoing compliance.
Standard #:	22VAC40-73-650-B
Description:	Based on information obtained during resident records reviewed with staff #1, the facility failed to ensure that the physician?s orders for administration of all prescription and over-the-counter medications for residents #3 and #6 contained information required by the regulation. Evidence: 1. The physician?s order for resident #3 dated 12-09-2019 did not include a diagnosis or specific indication for administering Nasacort. 2. The physician?s order for resident #6 dated 03-01-2020 did not include a diagnosis or specific indication for administering Cephalexin (Keflex) 500mg. 3. During the record review, staff #1 acknowledged that the physician?s orders did not include a diagnosis or specific indications for administering each drug.
Plan of Correction:	Resident #3 received updated order including diagnosis for Nasacort from physician. Resident #6 received updated order including diagnosis for Cephalexin (Keflex) 500mg from physician. All nurses and RMAs were re-in-serviced on Policy Med-01 Medication Management. Resident Care Director or designee will conduct a random medication pass audit a minimum of 16 times per month to ensure ongoing compliance and provide any necessary coaching on medication administration concerns.
Standard #:	22VAC40-73-660-B
Description:	Based on observation, record review, and interview with staff, the facility failed to ensure that residents that were not capable of self-medicating did not have medications in their rooms. Evidence: 1. During the facility tour with staff #2 the following was observed: A. A bottle of Chloraseptic Sore Throat spray was on the TV stand in the room of resident #11. B. Two tubes of Hydrocortisone cream were observed on the night stand in resident #12?s room, and; C. A tube of Vagisil and container of Nystatin topical powder was on a shelf in bathroom in the room of resident #13. 2. In reviewing the UAI?s in the records of resident #11, #12, and #13 with staff #1, there was no indication that these residents were capable of self-administering medications. The current UAI for resident 11, dated 02-20-2020, documented medications are to be administered by a lay person. The current UAI for resident #13 dated 06-28-2019, documented medications are to be administered by a lay person. The current UAI for resident #12, dated 09-16-2019 documented medications are to be administered by professional nursing staff. 3. During an interview with staff #1, it was acknowledged that residents #11, #12, and #13 were not permitted to keep medications in their room for self-medication based on their current UAI?s.
Plan of Correction:	Medications were removed from resident #11, #12, #13 room and secured in the medication cart. All nurses and RMAs were re-in-serviced on Policy Med-08 Resident Self-Management and Storage of Medication . Executive Director, Resident Care Director or designee will conduct a random room check minimum of 2 times per week to ensure medications are properly stored for all residents who are not permitted to self-administer medications.
Standard #:	22VAC40-73-680-D
Description:	Based on observation, record review, and interview, the facility failed to ensure that medications are administered in accordance with the physician?s or other prescriber's instructions and consistent with the standards of practice outlined in the current registered medication aide curriculum approved by the Virginia Board of Nursing. Evidence: 1. At approximately 9:01 A.M. during the morning medication pass observation with staff #3, resident #1 was observed sitting at the dining room table eating breakfast. Shortly thereafter, staff #3 was observed approaching resident #1 and then proceeded to escort resident #1 to their bedroom. Staff #3 then administered the resident?s medications which included Sucralfate 1GM/10ML. Resident #1 was then escorted back to the dining room to finish eating breakfast. 2. The Physician?s Order dated 03-09-2020 for resident #1 indicated that the medication Sucralfate 1GM/10ML was to be administered 2 hours after breakfast and not during breakfast as was observed. 3. During interview, staff #1 and staff #3 acknowledged the medication for resident #1 was not administered in accordance with the physician?s instructions.
Plan of Correction:	All nurses and RMAs were re-in-serviced on Policy MED-34 Administering Medications. Resident Care Director or designee will conduct a random medication pass audit a minimum of 16 times per month to ensure ongoing compliance and provide any necessary coaching on medication administration concerns.
Standard #:	22VAC40-73-860-I
Description:	Based on observation and an interview with staff, the facility failed to ensure that cleaning supplies were stored in a locked area. Evidence: 1. During the tour of the special care unit with staff #2 at approximately 3:27 PM, an unsupervised cleaning cart was observed near room #181 which contained an unlocked compartment. The following cleaning supplies were observed stored in the unlocked compartment: ?State Scentastic Lavender Neutral Cleaner?; ?State Triple Quick Disinfecting Cleaner?; ?NDC Morning Fresh Disinfectant Cleaner?; and ?Hope?s Perfect Stainless Polish.? 2. During an interview with staff #2, they stated that staff #7, responsible for the cleaning cart, was located in the ?break room? at the time of the tour.
Plan of Correction:	Re-in-serviced RCA, Maintenance Director and Housekeeping Associates on DSS regulation 860-I. Executive Director, Maintenance Director, or designee to will continue to round in the community minimum 2 times per day to ensure continued compliance.