VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Riverside Assisted Living at Warwick Forest
860 Denbigh Blvd.
Newport news, VA 23602
(757) 886-2000

Current Inspector: Willie Barnes (757) 439-6815

Inspection Date: June 23, 2020

Complaint Related: No

Areas Reviewed:

22VAC40-73 PERSONNEL 22VAC40-73 STAFFING AND SUPERVISION 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

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 5-26-20, 5-27-20, 5-28-20, 6-4-20, 6-5-20 and concluded on 6-8-20. The administrator was contacted by telephone to initiate the inspection. The administrator reported that the current census was 93. The inspector e-mailed the administrator a list of items required to complete the inspection. The inspector reviewed 5 resident records, 5 staff records, staff schedule, healthcare oversight, fire inspection, health department inspection, fire and emergency drills, oversight by the dietitian/nutritionist and new hire since last renewal inspection,and private sitters ( 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 #:	22VAC40-73-1140-B
Description:	Based on record review and staff interview, the facility failed to ensure within four months of the starting date of employment in the safe, secure environment, direct care staff shall attend at least 10 hours of training in cognitve impairment that meets the requirements of 22 VAC40-73-1140-C. Evidence: 1. During the remote inspection, a review of staff #2's training record documented 1.50 hours of cognitive training within fours months of hire; staff's date of hire noted as 5-20-19. 2. Further review of training records noted staff #5's record documented 3.75 hours of cognitive training within 4 months of hire; staff's date of hire noted as 5-6-19. 3. Staff #1 acknowledged staff's cognitive training not completed in the required time.
Plan of Correction:	1. Staff #2 and Staff #5 have been assigned the necessary trainings needed to meet the requirements on cognition impairment with anticipated completion by 7/25/2020. 2. The Nurse Educator/designee will complete a 100% audit of all staff training records to validate completion of all required courses. Staff members with outstanding training requirements will be scheduled for training with an established timeline for completion. 3. The Nurse Educator/designee will assign all required training at time of New Hire Orientation. New employees will be required to complete all mandatory education requirements in order to successfully complete facility orientation program. 4. The Administrator/designee will conduct an audit of three staff training records monthly for three months to validate staff member compliance with all required trainings. All completed actions will be submitted to the QA Committee for analysis and recommendation.
Standard #:	22VAC40-73-1140-E
Description:	Based on record review and staff interview, the facility failed to ensure within the first month of employment, staff, other than the administrator and direct care staff, who will have contact with the residents in the special care unit shall complete two hours of training one the nature and needs of residents with cognitive impairments due to dementia. Evidence: 1. During the remote inspection, a review of staff #6's (non-nursing staff) training record did not document training of cognitive impairment within the first month of employment; staff date of hire noted as 9-30-19. Documentation of cognitive training started on 2-17-20. 2. Staff #1 acknowledged the aforementioned staff cognitive training was not started within the first month of employment.
Plan of Correction:	.1. Staff #6 has been assigned the necessary trainings needed to meet the requirements on cognitive impairment with anticipated completion by 7/25/2020. 2. The Nurse Educator/designee will complete a 100% audit of all staff training records to validate completion of all required courses. Staff members with outstanding training requirements will be scheduled for training with an established timeline for completion. 3. The Nurse Educator/designee will assign all required training at time of New Hire Orientation. New employees will be required to complete all mandatory education requirements in order to successfully complete facility orientation program. 4. The Administrator/designee will conduct an audit of three staff training records monthly for three months to validate staff member compliance with all required trainings. All completed actions will be submitted to the QA Committee for analysis and recommendation.
Standard #:	22VAC40-73-210-B
Description:	Based on record review and staff interview, the facility failed to ensure all direct care staff attend at least 12 hours of training annual for staff who are licensed health care professionals or certified nursing aides. Evidence: 1. During the remote inspection, a review of staff #3's training record documented 5.50 hours of the required 12 hours of annual training; staff date of hire noted as 5-1-17. 2. Further review of training record for staff #4 noted documentation of 9.0 of annual training hours; date of hire noted as 2-20-17. 3. Staff #1 acknowledged staff record did not include documentation of the required hours of annual training.
Plan of Correction:	1. Staff #3 and Staff #4 have been educated on the importance of completing mandatory training. Mandatory training courses of at least 12 hours will be completed by each staff member. 2. The Nurse Educator/designee will complete a 100% audit of all staff training records to validate completion of all required courses. Staff members with outstanding training requirements will be scheduled for training with an established timeline for completion. 3. The Nurse Educator/designee will assign all required training at time of New Hire Orientation. New employees will be required to complete all mandatory education requirements in order to successfully complete facility orientation program. 4. The Administrator/designee will conduct an audit of three staff training records monthly for three months to validate staff member compliance with all required trainings. All completed actions will be submitted to the QA Committee for analysis and recommendation.
Standard #:	22VAC40-73-210-F
Description:	Based on record review and staff interview, the facility failed to ensure when adults with mental impairments reside in the facility, at least four of the required hours shall focus on topics related to residents' mental impairments. At least two of the required hours of training shall also focus on infection control and prevention. Evidence: 1. During the remote inspection, a review of staff #2's training record reviewed on 5-29-20 and 6-5-20 noted documentation of 1.50 hours of infection control training; staff date of hire noted as 5-20-19. 2. Further review of training documents, noted staff #3's training record noted documentation of zero hours of infection control and 1.50 hours of mental health training; staff date of hire noted as 5-1-17. 3. A review of staff #4's training record documented .50 hours of infection control training and 3.75 hours of mental health training; staff date of hire noted as 2-20-17. 4. Staff #1 acknowledged documentation of the aforementioned staff training not in training records.
Plan of Correction:	1. Staff #1 and #2 has been assigned infection control training to complete 0.5 hours outstanding, Staff #3 and Staff #4 are completing training on Mental Health (4 hours) and Infection Control (2 hours). The Nurse Educator will provide mental health training for staff on 6/23/2020. 2. The Nurse Educator/designee will complete a 100% audit of all staff training records to validate completion of all required courses. Staff members with outstanding training requirements will be scheduled for training with an established timeline for completion. 3. The Nurse Educator/designee will assign all required training at time of New Hire Orientation. New employees will be required to complete all mandatory education requirements in order to successfully complete facility orientation program. 4. The Administrator/designee will conduct an audit of three staff training records monthly for three months to validate staff member compliance with all required trainings. All completed actions will be submitted to the QA Committee for analysis and recommendation.
Standard #:	22VAC40-73-250-D
Description:	Based on document review and staff interview, the facility failed to ensure the a staff person was annually submitted the results of a risk assessment, documenting that the staff is free of tuberculosis (tb) in a communicable form. Evidence: 1. During the remote inspection, a review of staff #3's record revealed the date of the last tuberculosis screening was documented 8-20-18; staff's date of hire noted as 5-1-17. 2. Staff #1 acknowledged the aforementioned staff tuberculosis results was not conducted annually.
Plan of Correction:	1. Staff #3?s annual TB screening was completed immediately on date of survey. 2. A complete audit of annual TB screenings will be completed the Business Office Manager/designee with the assistance of Riverside Employee Health to ensure that all current employees have documentation showing that they are free of Tuberculosis in a communicable form. 3. During initial staff member orientation the Business Office Manager/designee will review all new hire TB documentation to validate TB screening has been completed. Annually a report will be generated as an audit tool to ensure all staff are free of TB in the communicable form. 4. The Unit Manager and/or designee will conduct an audit of the TB screen compliance report monthly for 3 months to validate staff member compliance. Completed actions will be submitted to the QA Committee for analysis and recommendation
Standard #:	22VAC40-73-260-A
Description:	Based on record review and staff interview, the facility failed to ensure a direct care staff record included documentation of adult first aid. Evidence: 1. During the remote inspection, a review of staff #2's record revealed the staff's first aid card did not document Adult First Aid, document noted first aide for K-12 schools. 2. Staff #1 acknowledged the staff's first aid document did not indicate Adult First Aid.
Plan of Correction:	1. Staff #2 will be complete adult CPR and first aid training on 6/25/2020. 2. A complete audit of staff CPR and First Aid will be completed with by the Nurse Educator/designee to validate compliance. 3. Nurse Educator will validate status of CPR/First Aid Training of new staff during initial orientation. New staff members who need to complete CPR/First Aid training will complete training prior to completion of new hire orientation. We will require a copy of Adult CPR card on hire and validate it is the approved CPR certification. 4. The Nurse Educator/designee will conduct monthly audits of all staff members? training records to ensure all Adult CPR/First Aid training is current. Completed actions will be submitted to the next QA Committee for analysis and recommendation.
Standard #:	22VAC40-73-290-A
Description:	Based on documents reviewed and staff interviewed, the facility failed to ensure the written work schedule included the names and job classification of all staff working each shift. Evidence: 1. During the remote inspection, a review of the environmental written work schedule submitted on 5-28-20 did not include the job classification of staff and only the first name of staff noted on the schedule. The resident services schedule did not include the job classification of staff listed. 2. Staff #1 acknowledge the written staff schedule did not include all required information.
Plan of Correction:	1. All schedules were updated immediately on date of survey with staff member?s First and Last Name. The Staff members? title was also included. 2. All department leaders have been educated by the administrator as of 6/15/2020 on the proper procedure when completing a work schedule per state regulation. 3. All department leaders will use the automated scheduling system to ensure compliance to include staff members? names and job classification and the shift worked. Each department leader will conduct a monthly audit of department schedule to ensure that all staff identification and job classification is listed. 4. All department work schedules will be reviewed by the Administrator/designee every 30 days for three months to ensure staff members full name and title are included. Completed actions will be submitted to the QA Committee for analysis and recommendation.
Standard #:	22VAC40-73-450-C
Description:	Based on record review and staff interview, the facility failed to ensure the comprehensive individualized service plan (ISP) included all assessed needs and services. Evidence: 1. During the remote renewal inspection, a review of resident #1's uniformed assessment instrument (uai) dated 10-14-19 indicated no toileting need, however, the individualized service plan (ISP) dated 5-14-20 documented "does need help- mechanical help" - grab bars and staff monitoring for ability to self-toilet.Resident #1's ISP documented "Home health for wound care", however, the document did not document who and when services are provided. Resident's 3-15-20 progress noted documented Homehealth visited and wrapped lower legs and 5-13-20 documented dressing to bottom (Duoderm). Resident self-administers and keep at bedside Biotene not noted on ISP, uai note medication administered by facility staff as assessed on uai. 2. A review of resident #2's uniformed assessment instrument dated 3-17-20 indicated bathing need, mechanical help/human help/physical assistance (mh/hh/pa), however the individualized service plan (ISP) documented mh/hh/pa- 1 person assist. Eating assessed mh/human supervision, however, the ISP noted encouragement, cut food, open carton, pour liquid and butter bread. Walking assessed,mh/hh/pa- not performed, however, the ISP noted not performed and no services to be provided noted on the ISP. Stairclimbing assessed not performed, however, no services to be performed noted on the ISP. Also not noted on the ISP, resident self-administers and keep at bedside Albuterol inhaler solution. Medication assessed to be administered by facility staff on uai and ISP. 3. A review of resident #3's uniformed assessment assessment (uai) dated 12-17-19 assessed no help for bowel, however, the individualized service plan (ISP) dated 12-27-19, updated 3-26-20 noted "does need help, incontinent less than weekly"- services provided-skin cleansing, disposal of products, by family, staff and sitter, every 2 hours. Wheeling is blank on the uai and the ISP noted "not performed" and no documentation of services performed or who provide services. Mobility assessed yes for help- confined move about, however, the ISP note "confined moves about-handrails w/stairs, participate in bus outings, in the facility and community." 4. A review of resident #4's uniformed assessment instrument (uai) dated 4-27-20 noted wheeling is blank, however, the individualized service plan (ISP) dated 4-27-20 noted wheeling not performed and no documentation of services to be provided and who will provide services. Stairclimbing assessed -no help/ not performed, however, the ISP noted not performed, handrails, facility staff to provide services as needed. 5. A review of resident #5's uniformed assessment instrument (uai) dated 5-20-20 noted no helping for wheeling- not performed, however, the individualized service plan (ISP) dated 5-20-20 noted does not need help- not performed and services provided and who provide services not documented on ISP.
Plan of Correction:	1. Resident #1, #2, #3, #4 and Resident #5 ISP and UAI were updated to include all assessed needs and services. 2. Unit Managers/designees will review 100% of resident records to validate UAIs and ISPs consistently address the individualized needs of each resident. 3. Nurse Educator will provide refresher training on the UAI/ISP completion and review process. 4. The Administrator/Designee will audit five resident?s annual UAI and ISP monthly for 3 months to ensure all needs are addressed on both documents and that staff are following the correct for updating the UAIs and ISPs. Completed actions will be submitted to the QA Committee for analysis and recommendations.
Standard #:	22VAC40-73-650-B
Description:	Based on document review and staff interview, the facility failed to ensure the physician or prescriber orders, both written and oral for administration of all prescription and over-the-counter medications and dietary supplements shall include all of the required information. Evidence: 1. During the remote inspection, resident #1's physician order dated 3-28-20 for Pyridium did not include the route and diagnosis, condition, or specific indications for administering the drug. 2. Further review of the record, the physician order dated 2-4-20 did not include diagnosis for the following: (a) Aspirin, (b) Lipitor, (c) Breo Ellipta, (d) Buspar, (e) Calmoseptine ointment, (f) Cardizem, (g) Cymbalta, (h) Foam Acrylic adhesive, (i) Lasix, (j) Incruse Ellipta inhaler, (k) Imdur, (l) Lamictal, (m) Toprol, (n) K-DUR, (o) Pradaxa, (p) Pred Forte Opthalmalic suspenion, (q) Deltasone, (r) Aldactone, (s) Venelex ointment and (t) Levalbuterol inhaler 3. A review of resident #2, physician order dated 5-1-20 for NP Thyroid did not include a diagnosis. 4. Staff #1 acknowledgement physician's order did not include all required information.
Plan of Correction:	1. The provider for Resident #1 clarified the order for Pyridium to include diagnosis, route, condition and specific indications for administering the medication. The physician also provided diagnoses for the medications listed in the report for Resident #1. The provider for Resident #2 clarified the order for NP Thyroid to include a diagnosis. 2. Unit Manager and/or designee will perform an audit of 100% of prescribed and over-the counter medication orders to ensure that all prescribed orders have required components present per state regulations, to include medication route and diagnosis. Any variances will be reported to the provider to obtain a clarification order. 3. All prescribers have been notified by written correspondence the administrator of the necessary components of a prescribed order per state guidelines. Nurse Educator/designee will provide refresher training to nurses and RMAs on required contents and transcription of medication orders prescribed or over-the-counter. Unit Manager and/or designee will review new medication orders to verify orders by the next business day to ensure each order contains all required information 4. The Administrator/designee will conduct random audit of 5 physician order forms containing new orders weekly for 12 weeks to validate new orders contain all necessary components per state guidelines. All completed actions will be submitted to the QA Committee for analysis and recommendation.
Standard #:	22VAC40-73-680-H
Description:	Based on document review and staff interview, the facility failed to ensure the medication administration record (mar) included all of the required information. Evidence: 1. During the remote inspection, resident #1's May 2020 medication administration record (mar) did not include the diagnosis, condition, or specific indications for administering the drug or supplement for: (a) Breo Ellipta, (b) Calcium Carbonate, (c) Docusate Sodium, (d) Incruse Ellipta Inhaler, (e) Lamictal, (f) Pyridium and (g) Venelex ointment. 2. A review of resident #2's May 2020 mar, NP Thyroid did not include a diagnosis. 3. Staff #1 acknowledged the medication administration record (mar) did not include all required information.
Plan of Correction:	1. Resident #1 and Resident #2 Medication Administration Records were updated to include all the required information, to include route, diagnosis and/or indication. 2. Unit Managers/designees will review 100% of the residents? Medication Administration Records and contact providers to obtain order clarifications as necessary. 3. Unit Managers and/or designee will review 10 resident records on each unit monthly to ensure compliance with all required components including diagnosis, condition or specific indications for administering the drug or supplements. 4. The Administrator/designee will complete monthly audit of 10 resident?s records per unit for three months to validate all orders contain required components for medication orders. Completed actions will be submitted to the QA Committee for analysis and recommendation.