VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Bickford of Virginia Beach
2629 Princess Anne Road
Virginia beach, VA 23456
(757) 821-0198

Current Inspector: Willie Barnes (757) 439-6815

Inspection Date: May 12, 2020 and May 13, 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

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 05-12-2020 and concluded on 05-13-2020. A self-reported incident was received by the department regarding allegations in the areas of Resident Care and Related Services.The Administrator was contacted by telephone to conduct the investigation. The licensing inspector emailed the Administrator a list of documentation required to complete the investigation. The evidence gathered during the investigation supported the self-report of non-compliance with standards or law, and violations were issued. Any violations not related to the self-report but identified during the course of the investigation can be found on the violation notice.

Violations:

Standard #:	22VAC40-73-650-B
Description:	Based on record review and interview, the facility failed to ensure the physician?s orders for administration of all prescription and over-the-counter medications identified the diagnosis or specific indications for administering each drug. Evidence: 1. Staff #1 provided a copy of resident #1?s current signed physician?s orders dated 01-14-2020. The orders did not include a diagnosis or specific indications for administering the following medications: Co Q-10 200mg cap, Furosemide 20mg tab, Lamotrigine 150mg tab, Pot Chloride 10 MEQ ER tab, Pramipexole 0.5mg tab, and Triamcinolon Cre 0.1%. 2. During an interview, staff #1 acknowledged resident #1?s physician?s orders did not include a diagnosis or specific indications for administering each drug.
Plan of Correction:	*100% review of all resident Physician Order Sheets was conducted to assure that all medications (prescription and over-the-counter) identified the diagnosis for why it is given and the indications for administering each medication. *RNC and ACC to review all new medication orders to assure they contain both the diagnosis and indications for administration prior to submitting to the pharmacy. *RNC and ACC to review and approve all new pharmacy profiled medication orders in the electronic Medication Administration Record to assure that they contain both the diagnosis and indications for administration. *Director, or designee, to monitor resident Physician Order Sheets to assure that they contain both an appropriate diagnosis and indications for administration.
Standard #:	22VAC40-73-680-I
Description:	Based on record review and interview the facility failed to ensure the Medication Administration Record (MAR) included the diagnosis, condition, or specific indications for administering the drug. Evidence: 1. Resident #1?s current physician?s orders dated 01-14-2020 documented Aspirin 81mg chew with a diagnosis (dx) of CAD; Celecoxib 200mg tab- dx: pain; Isosorb Mono 60mg tab- dx: HTN; Lisinopril 10mg tab- dx: HTN; Metoprol 50mg tab- dx: HTN; Omeprazole 20mg cap- dx: GERD; Rivastigmine 4.6mg/24 patch- dx: Dementia; Rosuvastatin 40mg tab- dx: Hyperlipidemia; Sertraline 100mg tab- dx: Depression; and Docusate 100mg cap- dx: Constipation. 2. Resident #1?s January, February, and March 2020 MAR?s did not document the diagnosis, condition, or specific indications for administering Aspirin 81 mg, Celecoxib 200mg, Isosorb Mono 60mg, Lisinopril 10mg, Metoprolol 50mg, Omeprazole 20mg, Rivastigmine 4.6/24, Rosuvastatin 40mg, Sertraline 100mg, or Docusate 100mg. 3. During an interview, staff #1 acknowledged resident #1?s MAR?s did not include the diagnosis, condition, or specific indications for administering the drugs.
Plan of Correction:	*100% review of all resident Medication Administration Records was conducted to assure that all prescribed medications (prescription and over-the-counter) identified the diagnosis, condition, or specific indications for administering each medication. *RNC and ACC to review all resident Medication Administration Records to assure they contain the diagnosis, condition, or indications for administering each medication ordered by the physician. *Director, or designee, to monitor resident Medication Administration Records to assure they contain the diagnosis, condition, or indications for administering each medication ordered by the physician.
Standard #:	22VAC40-73-930-D
Description:	Based on record review and interview, the facility failed to make and document rounds no less than every two hours for each resident with an inability to use the signaling devices, once the resident has gone to bed each evening until the resident has arisen each morning. Evidence: 1. Resident #1 was placed in the Special Care Unit on 02-19-2020. The facility?s ?Approval for Placement in Special Care Unit? form was dated 02-17-2020 and documented, ?Due to the loss of executive function and the inability to make safe and sound decisions for [resident], a transfer to Mary B?s [special care unit] is appropriate for [resident] for increased supervision and interaction.? The resident?s physician assessed the resident and documented that the ?resident is oriented x1, has a serious cognitive impairment due to a primary psychiatric diagnosis of dementia, and is unable to recognize danger or protect their own safety or welfare? on the ?Assessment of Serious Cognitive Impairment? form which was signed and dated on 01-29-2020. 2. Resident #1?s most current Individualized Service Plan dated 01-05-2020 documented ?2 hour checks- staff will check on resident every 2 hours and as needed to ensure [resident] has not fallen or needs assistance.? 3. On 05-14-2020, staff #1 provided documentation of the facility?s two-hour rounds for the special care unit, which was labeled ?Resident Apartment Nighttime Safety Checks Daily Log (VA).? Documented on the forms was ?All residents that are cognitively impaired and unable to call, seek help, or use the call system in their apartment as night will be noted below and will receive apartment checks every two hours.? The forms identified the residents by room number. Resident #1 resided in Room #510 as confirmed by staff #1. The ?Resident Apartment Nighttime Safety Checks Daily Log (VA)? did not include the staff initials to indicate 2 hour rounds were completed every two hours for resident #1 on the following days: A. On 03-01-2020 and 03-03-2020, the last documented two hour round conducted by staff was 11:00 PM. The 1:00 AM, 3:00 AM, and 5:00 AM two hour rounds were left blank; B. Staff #1 stated she could not locate or provide ?Resident Apartment Nighttime Safety Checks Daily Log (VA)? documenting rounds made by direct care staff every two hours on 03-02-2020, 03-04-2020 through 03-07-2020, 03-12-2020, and 03-14-2020. 4. Staff #1 was requested to provide any additional supporting documentation for resident #1 that would determine the two hour rounds had been conducted during the aforementioned dates and times, however; staff #1 did not provide additional documentation after searching ?each day? for ?approx. sixteen hours.? 5. During an interview, staff #1 acknowledged the direct care staff did not make rounds every two hours as required.
Plan of Correction:	*RNC and ACC retrained on the requirement that safety checks occur on the Special Care Unit every 2 hours, from the time residents go to bed at night until they awaken in the morning. *RNC and ACC to conduct training to educate the staff that all Special Care Unit residents are to receive safety checks every 2 hours from the time that residents go to bed at night until they awaken in the morning. This training will be documented. *ACC, or RNC in her absence, to check and initial the ?Resident Apartment Nighttime Safety Checks? sheet for each day of the month to assure that it is complete and being used properly. *Director to review the ?Resident Apartment Nighttime Safety Checks? sheets and assure that they are properly secured and stored, by month, at the conclusion of each month.