VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Commonwealth Senior Living at Berryville
413 McClellan Street
Berryville, VA 22611
(540) 955-4557

Current Inspector: Sarah Pearson (540) 680-9469

Inspection Date: May 27, 2020 and May 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 EMERGENCY PREPAREDNESS 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS Article 1 Subjectivity 22VAC40-90 Background Checks for Assisted Living Facilities 22VAC40-90 The Sworn Statement or Affirmation 22VAC40-90 The Criminal History Record Report

Technical Assistance:

1. When indicating someone cannot use a call bell the times for rounds need to be indicated on the service plan. 2. The service plan needs to include the name of the hospice or home health agency providing that service. 3. Suggest the prn trazadone order for resident A indicate during sleep hours only.

Comments:

This inspection was conducted by licensing staff using an alternate remote protocol necessary due to a state of emergency health pandemic declared by the Governor of Virginia. A renewal inspection was initiated on 5/26/2020 and concluded on 5/28/2020. The administrator and director of nursing were contacted by email to initiate the inspection. The administrator reported that the current census was 46. The inspector emailed the administrator and director of nursing a list of things required to complete the inspection. The inspector reviewed four resident charts including notes and medication records. Four staff records were reviewed that included training,any certification requirements and staff scheduling. The inspection also included review of fire and health inspections, emergency drills, health care, dietary and pharmacy over site all submitted by the facility to ensure documentation was complete. Information gathered during this renewal inspection determined non-compliance with one applicable standard or law, and the violation was documented on the violation notice issued to the facility. Thank you to staff and administration for your patience and assistance during this desk review process. You will be notified by mail regarding your renewal status following review by the licensing administrator. Should you have additional questions or concerns please call (540) 332-2330 or e-mail this inspector at sharon.deboever@dss.virginia.gov.

Violations:

Standard #:	22VAC40-73-680-D
Description:	Based on a desk review of resident records which included medication administration records (MARs), the medication record for resident C had areas where there were no initials to indicate that medication had been given. This same resident has two medications for pain with no indication which should be given first. Daily blood pressure checks and daily weights are ordered with no parameters for contacting the physician. This resident was also identified as having a stage III wound which should have been reported to the licensing office along with weekly measurements. Resident B had multiple incidents of "med not available" and recommend clarification on the lidocaine patch order. (Also note: The service plan for this resident says alert and oriented to all spheres while the UAI notes disorientation to all spheres.)
Plan of Correction:	The DON with the administrator will review these items for correction and future compliance. Staff training will be provided as applicable to each situation. Physician orders will be clarified. The DON assumes future responsibility.