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Cary Adult Home
7336 Cary Avenue
Gloucester, VA 23061
(804) 693-7035

Current Inspector: Willie Barnes (757) 439-6815

Inspection Date: May 4, 2020 , May 5, 2020 and May 8, 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 EMERGENCY PREPAREDNESS
22VAC40-90 Background Checks for Assisted Living Facilities
22VAC40-90 The Sworn Statement or Affirmation
22VAC40-90 The Criminal History Record Report

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 5-4-20 and concluded on 5-8-20. The administrator was contacted by telephone to initiate the inspection. The administrator reported that the current census was 53. The inspector e-mailed the administrator a list of items required to complete the inspection. The inspector reviewed 4 resident records, 4 staff records, staff schedule, healthcare oversight, fire inspection, health department inspection, fire and emergency drills, oversight b dietitian/nutritionist and new hire since last renewal inspection ( date of hire, sworn statement/affirmation and criminal history record report.

Information gathered during the inspection determined non-compliances with applicable standards or law, and violations were documented on the violation notice issued to the facility.

Violations:
Standard #: 22VAC40-73-70-A
Description: Based on record review and staff interview, the facility failed to ensure it reported to the regional licensing office within 24 hours any major incident that has negatively affected or threatens the life, health, safety or welfare of any resident.

Evidence:
1. During the remote inspection, a review of resident #2's nurse's note documented by staff #3 on 12-5-19, "resident attacked by another resident around 7:00 pm. The cops were notified, and came to the home".
2. A review of resident #4's nurses note documented on 10-19-19, resident #4 "slammed hand in the door, hand swollen. Resident #4's nurses note documented on 12-18-19, resident sustained a fall, forehead wound not stop bleeding, resident sent out to ER.
3. On 5-6-20, during a review of information, staff #1 acknowledged not reporting incident to the licensing office for resident #2 and resident #4.

Plan of Correction: Administrator and/or designee will report to the regional licensing office within 2 hours any major incident that affects the life, health, safety or welfare of any resident.

Dates to be corrected
May 13, 2020 and ongoing

Standard #: 22VAC40-73-120-B
Description: Based on record review and staff interview, the facility failed to ensure staff orientation included all required information per the regulation for two of four staff records.

Evidence:
1. During the remote inspection review of staff records, staff #4 (orientation date 2-26-19) and staff #5 (orientation date 1-20-19) record did not document orientation did not include documentation of the following: (a) facility's organizational structure, (b) facility policies and procedures, and (c) specific duties and responsibilities of their positions.
2. Staff #1 acknowledged staff's orientation did not include all required information.

Plan of Correction: Administrator and/or designee will insure staff #4 and #5 staff records include documentation of orientation to include the organizational structure, policies and procedures and staff specific duties and responsibilities

Dates to be corrected
May 29, 2020

Standard #: 22VAC40-73-120-C
Description: Based on record review and staff interview, the facility failed to ensure staff was trained in all required relevant laws, regulations, and the facility's policies and procedures to implement requirements of the regulation for two of four staff.


Evidence:
1. During the remote inspection review of staff records, staff #4 (orientation date 2-26-19) and staff #5 (orientation date 1-20-19), the record noted orientation did not include documentation of the following:(a) handwashing techniques, standard precautions, infection risk-reduction behavior and other infection control measures specificed in 22VAC 40-73-100 and (b) procedures for reporting and documenting incidents as required in 22 VAC 40-73-70.
2. Staff #1 acknowledged staff #4 and staff #5's record did not include all required orientation and training.

Plan of Correction: Administrator and/or designee will insure staff #4 and #5 staff records will have the DSS
staff orientation record from 2/18 to insure all required orientation is complete

Dates to be corrected
May 29, 2020

Standard #: 22VAC40-73-200-C
Description: Based on record review and staff interview, the facility failed to ensure direct care staff shall meet the requirements for direct staff qualifications. If the staff does not meet the requirement at the time of employment, staff shall successfully meet one of the requirements per the regulation within two months of employment.

Evidence:
1. During the remote inspection, a review of staff #4's date of hire was noted as 2-26-19 (2-22-19). Staff's job description dated 2-26-19 indicated staff as a direct care staff. However, staff did not have previous direct care training and staff certificate noted direct care training completed 6-18-19.
2. Staff #1 acknowledged staff #4 was hire as a direct care staff, but training was not completed within the regulation requirements.

Plan of Correction: Administrator and/or designee will review staff records to insure correct job position is listed on application and specific job duties and training is complete

Dates to be corrected
May 29, 2020

Standard #: 22VAC40-73-210-F
Description: Based on record review and staff interview, the facility failed to ensure staff completed all required hours of annual training as required per the regulation.

Evidence:
1. During the remote inspection, a review of staff #3's annual training (date of hire 8-21-18) did not have documentation of the required four hours of mental health training and two hours of annual infection control training.
2. Further review of staff #4's record (date of hire 2-26-19/2-22-19) record did not have documentation of required two hours of annual infection control training.
3. Staff #1 acknowledged staff #3 and #4 did not have documentation of all required training.

Plan of Correction: Administrator and/or designee will insure all staff have the required training hours on mental health training and infection control

Dates to be corrected
June 30, 2020 and/or when outside trainers can come to the facility

Standard #: 22VAC40-73-260-A
Description: Based on record review and staff interview, the facility failed to ensure direct care staff receive certification in first aid within 60 days of employment.

Evidence:
1. During the remote inspection, a review of staff #3's record, staff's date of hire noted as 8-21-18 and direct care job description dated 8-21-18. Staff #3 required to complete first aid training within 60 days of hire; record indicated first aid training completed 12-3-18.
2. Staff #1 acknowledged staff did not receive first aid training within 60 days of hire.

Plan of Correction: Administrator and/or designee will schedule first aid/cpr training classes to meet the requirement within 60 days of employment.

Dates to be corrected
June 30, 2020 and/or when group training can occur in the facility

Standard #: 22VAC40-73-280-E
Description: Based record review and staff interview, the facility failed to ensure no employee shall be permitted to work in a position that involves direct contact with resident until background check has been received as required in the Regulation for Background Checks for Assisted Living Facilities and Adult Day Care Center (22VAC40-90).

Evidence:
1. During the remote inspection, a review of staff #7's documents revealed the staff's date of hire was 2-26-20, the date of the criminal record report was dated 1-6-20. Staff did not meet criteria for employment in the assisted living facility.
2. Staff #1 acknowledged the report review did not meet assisted living facility criteria.

Plan of Correction: Staff #7 was terminated immediately (corrected) and Administrator and/or designee will review all staff background checks and compare with the Barrier Crimes List to insure all staff meets the requirement for current staff and future staff.

Dates to be corrected
May 22, 2020

Standard #: 22VAC40-73-290-A
Description: Based on document review and staff interview, the facility failed to ensure the written work schedule included all of the required regulation information.

Evidence:
1. During the remote inspection, a review of the facility's April 2020 schedule did not include the names of the staff scheduled to work. The schedule reviewed noted initials of individuals. The job classification of staff was also not documented on the April 2020 work schedule. The shift/ schedule hours is not documented.
2. Staff #1 and #2 acknowledged the written scheduled did not include all required information.

Plan of Correction: Administrator and/or designee will insure the staff schedule meets all the required regulation information

Dates to be corrected
June 1, 2020

Standard #: 22VAC40-73-320-A
Description: Based on record review and staff interview, the facility failed to ensure the physical examination report included all of the required information for two of four residents.

Evidence:
1. During the remote inspection, a review of resident #3's physical examination document (date-7-23-19) and resident #4's (date 7-18-19 did not include the address, telephone number and self-administration information.
2. Staff #1 acknowledge the physical examination did not include all of the required information.

Plan of Correction: Administrator and/or designee will contact resident #3 & #4 physician to request corrected information for their physical.

Dates to be corrected
May 22, 2020

Standard #: 22VAC40-73-450-C
Description: Based on record review, the facility failed to ensure the comprehensive individualized service plan (ISP) included all assessed needs for two of four residents.

Evidence:
1. During the remote inspection, resident #1's uniformed assessment instrument (uai) dated 4-13-20 noted the resident use a cane/ walker to walk. However, the mobility and stairclimbing need was assessed as not needing assistance. A fall risk assessment dated 4-13-20, with a score of eight and facility to monitor resident was also reviewed.
2. Resident #2, uniformed assessment instrument dated 11-22-19 noted resident need for day support services, a review of the ISP dated 12-11-19 did not indicate day support service. Staff #1 confirmed resident attends a day support program.
3. Staff #1 acknowledged all residents assessed needs were not documented on the resident's individualized service plan.

Plan of Correction: Administrator and/or designee will correct Residents 1 & 2's ISP and/or UAI to reflect the correct assessed needs. Administrator and/or designee will review ISP's as they are completed, upon admission and/or when needs change.

Dates to be corrected
May 29, 2020

Standard #: 22VAC40-73-650-A
Description: Based on record review and staff interview, the facility failed to ensure no medication was started, changed, or discontinued by the facility without a valid order from a physician or other prescriber.

Evidence:
1. During the remote inspection, a review of resident #1's April 2020 medication administration record (MAR) noted Benzonatate (Tessalon Perle 100 mg) discontinued, a review of the physician's order dated 11-12-19 and 6-25-19 document submitted did not include a physician's order indicating discontinuation of the aforementioned medication.
2. Staff #1 acknowledged physician's order to discontinue not in current record submitted.

Plan of Correction: Administrator and/or designee will contact resident #1 physician to insure a discontinue order is on file.

Dates to be corrected
May 29, 2020

Standard #: 22VAC40-73-650-B
Description: Based on record review and staff interview, the facility failed to ensure the physician or prescriber order for all prescription and over-the-counter medications and dietary supplements shall include all of the required information.

Evidence:
1. During the remote inspection, resident #4's physician's order did not identify the diagnosis, condition, or specific indications for administering the following drug prescribed on 2-17-20 physician order: (a) Cholecalciferol (Vitamin D), (b) Prilosec, (c) Azelastine, (d) Loratadine and (e) Meloxicam.
2. A review of resident #2's physician order dated 12-19-19, Methazolamide did not include a diagnosis.
3. Staff #1 acknowledged physician's order did not include diagnosis for resident #2 and #4.

Plan of Correction: Administrator and/or designee will contact resident #4 & resident #2 physician to request diagnosis for medications prescribed.

Dates to be corrected
May 29, 2020

Standard #: 22VAC40-73-680-D
Description: Based on record review and staff interview, the facility failed to ensure medication was administered in accordance with the physician or other prescriber's instruction and consistent with the standards of practice outlined in the current registered medication aide curriculum approved by the Virginia Board of Nursing.

Evidence:
1. During the remote inspection, resident #2's April 2020 medication administration record (MAR) noted Fluticasone (Flonase)- two spray in each nostril every day. However, the physician order dated 12-19-19 noted two spray in each nostril in each nostril as needed (PRN).
2. Staff #1 acknowledged physician's orders and administration not the same.

Plan of Correction: Administrator has a copy of the current order from February 5, 2020 with the correct information that matches the April MAR. Administrator and/or designee will review all new orders to insure the MAR reflects the physician orders as written.

Dates to be corrected
May 18, 2020 and ongoing

Standard #: 22VAC40-73-680-K
Description: Based on record review and staff interview, the facility failed to ensure the administration of PRN medication indicate the exact dosage.

Evidence:
1. During the remote inspection, resident #4's medication Triamcinolone (Kenalog) noted apply 1-2 times daily, as needed, for prescription dated 2-17-20.
2. Staff #1 acknowledged as needed (prn) medication for resident #4 was not exact dosage.

Plan of Correction: Administrator and/or designee will contact resident #4's physician to get prescription corrected to reflect exact dosage.

Dates to be corrected
May 29, 2020

Disclaimer:
A compliance history is in no way a rating for a facility++.

The online compliance history includes only information after July 1, 2003. In addition, the online compliance history includes information regarding adverse actions that may be the subject of a pending appeal. An adverse action is not final until a provider has exhausted or waived all due process rights. For compliance history prior to July 1, 2003, or information regarding the status of pending adverse actions, please contact the Licensing Inspector listed in the facility's information. The Virginia Department of Social Services (VDSS) is not responsible for any errors in or omissions from the compliance history information.

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