VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Brookdale Harrisonburg
2101 Deyerle Avenue
Harrisonburg, VA 22801
(540) 574-2982

Current Inspector: Jessica Gale (540) 571-0358

Inspection Date: April 21, 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. 22VAC40-90 Background Checks for Assisted Living Facilities 22VAC40-90 The Sworn Statement or Affirmation 22VAC40-90 The Criminal History Record Report

Technical Assistance:

Discussion occurred on the following topics: 1) Mobility refers to movement outside of the facility. 2) UAI to indicate medication administration by lay person to include RMA 3) Consistent use of ISP format as indicated for resident D.

Comments:

This inspection was conducted by licensing staff using an alternate protocol, necessary due to a state of emergency health pandemic declared by the Governor of Virginia. A renewal inspection was initiated on 04/21/20 and concluded on 04/24/20. The ED was contacted by telephone to initiate the inspection. The ED reported that the current census was 52. The inspector emailed the ED a list of items required to complete the inspection. The inspector reviewed four resident records and four staff records including physician's orders and medication administration records. Staff schedule and criminal history reports were reviewed. These items were submitted by the facility to ensure documentation was complete. Information gathered during the inspection determined non-compliance with applicable standards or law, and violations were documented on the violation notice issued to the facility.

Violations:

Standard #:	22VAC40-73-440-D
Description:	Based upon review of residents' records, the facility failed to ensure the Uniform Assessment Instrument (UAI) included all required information. EVIDENCE: 1) The UAI for residents A, B and C did not include signature of the administrator for approval. a. The medication administration section on the UAI for resident A is not complete.
Plan of Correction:	The Uniform Assessment Instrument (UAI) for Residents A, B and C will be reviewed by the Executive Director and signed for approval and The UAI for Resident A, B and C will also be updated to reflect complete medication administration status no later than 4/28/2020. The Executive Director will provide education for the Health and Wellness Director on Uniform Assessment Instrument (UAI) compliance by 4/28/2020.The Health and Wellness Director and the Executive Director will audit of all current residents Uniform Assessment Instrument (UAI) for Executive Director signature and to ensure completion of UAI to be completed by 6/8/2020. The Health and Wellness Director or Designee will audit current residents Uniform Assessment Instrument (UAI) for Executive Director signature and completion of UAI once a month for three months to ensure on going compliance.
Standard #:	22VAC40-73-450-C
Description:	Based upon review of residents' records, the facility failed to ensure all assessed needs are included on the Individualized Service Plan (ISP). EVIDENCE: 1) The UAI for resident A indicates the use of grab bar is needed for toileting. The ISP indicates the resident is independent. a. The UAI indicates the use of handrail is needed for stair climbing. This is not addressed on the ISP. b. The ability to use call system is not indicated on the ISP. c. Medication administration is not addressed on the ISP. d. Copy of ISP received by legal representative is not indicated. 2) The UAI for resident B indicates physical assistance is needed with wheeling. This is not addressed on the ISP. a. The UAI indicates physical and mechanical assistance is needed with walking. This is not addressed on the ISP. b. The UAI indicates disorientation to place and time. This is not addressed on the ISP. c. The ability to use call system is not indicated on the ISP. . d. Copy of ISP received by legal representative is not indicated. 3) The UAI for resident C indicates only supervision is needed with transferring, The ISP indicates resident uses a walker to transfer. a. The UAI indicates no assistance is needed with walking. The ISP indicates mechanical assistance of walker. b. The UAI indicates no assistance is needed with mobility. The ISP indicates mechanical assistance of walker. c. Assistance with medication administration is not indicated on the ISP. d. The UAI indicates resident is disoriented to time. This is not addressed on the ISP. e. The ability to use call system is not indicated on the ISP. f. Copy of ISP received by legal representative is not indicated. 4) The UAI for resident D indicates physical assistance is needed with wheeling. This is not addressed on the ISP. a. The UAI indicates behavior of wandering. This is not addressed on the ISP. b. The UAI indicates disorientation to time, person and place. This is not addressed on the ISP.
Plan of Correction:	The Individualized Service Plans (ISP) for Residents A, B, C and D will be reviewed by the Health and Wellness Director, Executive Director or Designee and will be updated to reflect current identified needs, services, who will provide services, expected outcomes and completion no later than 5/01/2020.The Executive Director will provide education for the Health and Wellness Director and Health and Wellness Coordinator on Individualized Service Plans (ISP) compliance by 5/01/2020. The Health and Wellness Director or Designee will audit of all current residents Individualized Service Plans (ISP) for current resident identified needs/services/providers/outcomes and to ensure completion of ISP to be completed by 6/8/2020. The Health and Wellness Director or Designee will audit current residents Individualized Service Plans (ISP) for identified resident needs and completion of ISP once a month for three months to ensure on going compliance.