VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Green Valley Commons Assisted Living
549 Valley Mill Road
Winchester, VA 22602
(571) 359-1499

Current Inspector: Sarah Pearson (540) 680-9469

Inspection Date: June 9, 2020 and June 10, 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 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:

1 . The units given for sliding scale insulin need a place to be consistently recorded and should have parameters along with regular insulin administration. 2. Blood sugar checks being done outside of insulin administration (resident E) should also have parameters such as when to notify physician or what to do if below a certain level. 3. Clarify order for resident B indicating to notify physician of a weight gain of more than 210 lbs.

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 monitoring inspection was initiated on 6/8/2020 and concluded on 6/10/2020. The administrator was contacted by email to initiate the inspection. The administrator reported that the current census was 34. The inspector emailed the administrator a list of things required to complete the inspection. The inspector reviewed three resident charts including notes and an additional six medication records. Three staff records were reviewed that included training, background checks, 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-C
Description:	Based on a desk review of May, 2020 medication administration records (MARs), medication was not consistently administered or documented as administered as per physician orders. Resident D - the number of units of insulin given based on the sliding scale and MAR documentation is incorrect for 7:30am May 19,20 and 21, at 11:30am for May 20,21 and 28 and at 4:30pm May 27. The same is true for the humalog order for 7 units three times a day at 7:30am on 5/ 17,20 and 21, 11:30am dose on 5/20, 21 and 28 and the 4:30pm dose on 5/27. The blood sugars do not match for sliding scale and humalog at 7:30am on the 17th. Lantus was held at 8pm on 5/17 with a note indicating " parameter not met" but the order has no parameters stated and there is no blood sugar reading noted. Resident F: On 5/27 at 11:30am blood sugar was documented at 280 which would require five units on sliding scale and 3 units were noted as given; the blood sugar for 7:30am on the 27th is noted to be 91 on page 1 of MAR and 238 on page 2 (with sliding scale); consider discontinuing night polyethlene glycol dose as 27 refusals noted for the month and no inidcation physician was notified. Resident H: Has an PRN orders for hydroxyzine for anxiety that is to be used first and if not effective then aitivan can be given as per order. On 5/7, 5/27 and 5/28 ativan was given instead of hydroxyzine. On 5/11 they were both given at the same time. Olanzipine which is noted PRN for agitation and psychosis was given 5/4.5.6,8,23,24,25 and 28 for anxiety. The dose on the 28th was noted to be given at the same time as a dose of hydroxyzine. There was no documentation physician or nurse were notified related to medication refusals. Resident I: 6:00am dose of lantus was held on 5/14, 27 and 31 noting "parameter not met" but the physician's order has no parameters.
Plan of Correction:	Administrator will review and clarify orders, including the addition of applicable parameters. Staff will receive additional training as it relates to insulin administration, particularly for sliding scale insulin. They will also receive training as it relates to individuals who may have multiple medications with the same diagnosis and the proper order for administration. This training will be documented. The administrator assumes responsibility for correction and future complaince.