VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Riverside Assisted Living at Patriots Colony
6200 Patriots Colony Drive
Williamsburg, VA 23188
(757) 220-9000

Current Inspector: Willie Barnes (757) 439-6815

Inspection Date: June 10, 2020 , June 12, 2020 , June 16, 2020 and June 17, 2020

Complaint Related: No

Areas Reviewed:

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

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 6-9-20; 6-10-20, 6-12-20, 6-16-20 and concluded on 6-17-20. The administrator was contacted by telephone to initiate the inspection. The administrator reported that the current census was 54. The inspector e-mailed the administrator a list of items required to complete the inspection. The inspector reviewed 4 resident records, 4 staff records, physician's orders, staff schedule, healthcare oversight, health department inspection, fire and emergency drills, and new hire since last renewal inspection date, 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 starting date of employment in the safe, secure environment, direct care staff shall attend at least 10 hours of training in cognitive impairment that meets the requirements of 22VAC40-73-1140-C for one of four staff. Evidence: 1. During the remote renewal inspection, a review of staff #4's record on 6-10-20 and 6-12-20, noted the following cognitive training hours listed on the facility's training transcript submitted for review: 3-17-20 (.10 and .12 hrs) and 3-18-20 (.13 and .10 hrs). Staff date of hire was documented as 11-18-19. 2. Staff #1 acknowledged staff training hours did not meet requirement.
Plan of Correction:	1) Staff member completed additional training to complete outstanding courses to meet10 hour education requirement. 2) Audit files of team members hired within the last 12 months to ensure completion 10 hour cognitive impairment training. 3) All new direct care staff will complete10 hours of cognitive impairment training during orientation program? 4) Educator will audit training records of new direct care staff team members. Monthly results will be reported to administrator or AL Director monthly. 5) Results will be reported at QA Meeting.
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 residents in the special care unit shall complete two hours of training on the nature and needs of residents with cognitive impairments due to demential for one of four staff. Evidence: 1. During the remote renewal inspection, a review of staff #5's record on 6-10-20 and 6-12-20 and the training transcript submitted for review did not document cognitive impairment training prior to 11-28-19. Staff #5's date of hire documented as 8-12-19 was confirmed on 6-16-20. 2. Staff #1 acknowledged the staff's training not completed according to the regulation time-frame.
Plan of Correction:	1) Team member #5 assigned training on mental impairments to ensure that 4 hours of training needed is met. 2) Audit all staff records to ensure 4 hours of training on mental impairment from June 2019 to June of 2020. 3) Staff not meeting the 4 hours of mental/cognitive impairment training will be assigned additional training. Educator will assign 4 hours of mental/cognitive impairment training to staff annually, and check for completion monthly. 4) Educator will audit completion of required education monthly and report results monthly to administrator and AL Director for follow up. 5) Outcomes will be reviewed by QA for analysis and recommendations
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 for two of four staff. Evidence: 1. During remote renewal inspection, a review of staff #2's record on 6-10-20 and 6-12-20 documented the following mental impairment training hours: 6-19-18 (1.00 hrs) and 8-8-19 (.50 hrs). Staff #2's date of hire confirmed on 6-16-20 as 10-15-17. 2. Further review of staff records, staff #3's record did not document impairment training hours on the facility training transcript submitted for review on 6-10-20 and 6-12-20. Staff #3's date of hire noted as 2-20-17. 3. Staff #1 acknowledged staff training hours did not meet requirement.
Plan of Correction:	1) Team members #2 and 3 that did not have training on cognitive impairment r/t dementia received education to meet the two hour requirement. 2) Educator will audit non-direct care staff/administrator education records for compliance with two hours of cognitive impairment training r/t dementia. 3) Team members not meeting the required education will receive training on cognitive impairments r/t dementia. Staff, other than administrator and direct care staff who will have contact w/residents in special care unit, will receive two hours of training on cognitive impairments r/t dementia. 4) Educator will check new hire files to confirm completion two hours of training monthly. 5) Findings will be reviewed by QA for analysis and recommendations
Standard #:	22VAC40-73-290-A
Description:	Based on document review and staff interview, the facility failed to ensure it maintained a written work schedule that includes the names and job classification of all staff working each shift, with an indication of whomever is in charge at any given time. Evidence: 1. During the remote renewal inspection, a review of the staff schedule submitted on 6-12-20 for the Activity staff did not include the job classification of staff working. The schedule submitted also listed only the first name of staff. 2. Staff #1 acknowledged the activity staff did not meet the regulation requirement.
Plan of Correction:	1) The identified activity staff that work in AL were added to the daily staffing postings and posted at nurse?s station. 2) All other departments other than nursing that work in AL have been added to the daily staffing sheets posted at the nurse?s station. 3) Leaders are notifying the scheduler each morning as to who works that day and she is adding to the daily posting and placed outside each nurse?s station. 4) AL Director or Designee will audit postings 3 times a week for 4 weeks 5) Findings will be reported out to QAPI.
Standard #:	22VAC40-73-450-C
Description:	Based on record review and staff interview, the facility failed to ensure the individualized service plan (ISP) shall include all assessed needs for three of four residents. Evidence: 1. During the remote renewal inspection, a review of resident #2's uniformed assessment instrument (uai) dated 2-28-20 indicated toileting and transferring assessed as mechanical help (mh); however, the individualized service plan (ISP) dated 3-7-20 indicated toileting (grab-bar) and transferring (rollator/ arms of chair), and the person who will provide service is noted as facility staff. 2. A review of resident # 3's uniformed assessment instrument (uai) dated 8-1-19 and 9-3-19 indicated dressing, toileting and bowel assessed as no help needed, however, the individualized service plan (ISP) dated 9-3-19 noted "does need help", no services noted and who will provide services not noted. Further review of the uai indicated wheeling assessed no help needed, however, the ISP noted not performed and no services and who would provide services noted. 3. A review of resident #4's uniformed assessment instrument (uai) dated 2-1-20 noted toileting, walking and transferring need assessed as mechanical help(mh), however, the individualized service plan (ISP) dated 2-1-20 noted grab bar and who will provide services noted as facility staff. Eating/feeding assessed as human help/physical assistance (hh/pa), however, the ISP did not note what services to be provided. Stairclimbing assessed as not performed, however, the ISP did not indicate what services would be provided and who would provide services. 4. Staff #1 acknowledged ISP did not reflect assessed needs for residents.
Plan of Correction:	1. ISP for residents #2, 3, and 4 were reviewed and dated to include all assessed needs and services. 2. AL Director/designee will review 100% of ISP?s to confirm documents accurately reflect the current individualized needs of each resident. Nurse Educator will provide refresher training on the ISP completion and review process. 3. The AL Director/designee will audit 5 resident ISPs weekly for 4 weeks then monthly for 3 months to ensure current resident needs are addressed on the document. 4. Outcomes will be reviewed by the QA for analysis and recommendations.
Standard #:	22VAC40-73-450-D
Description:	Based on record review and staff interview, the facility failed to ensure when hospice care is provided to a resident, the assisted living facility and the licensed hospice organization shall communicate and establish an agreed upon coordinated plan of care for the resident. The services provided by each shall be included on the individualized service plan. Evidence: 1. During the remote renewal inspection, a review of resident #1's individualized service plan (ISP) dated 3-3-20 submitted on 6-10-20 did not include resident's hospice service. 2. A request for hospice service physician's order requested and received on 6-12-20 noted resident's admission to hospice care signed and dated by physician on 4-20-20. Further review of the resident's "Narrative note" dated 4-20-20 documented resident #1's hospice care. 3. Staff #1 acknowledged the hospice services were not documented on the resident's ISP prior to 6-12-20.
Plan of Correction:	1) ISP for Resident #1 was updated to reflect hospice services. 2) AL Director/Designee will review 100% of records of residents on hospice to ensure ISP reflects hospice services. 3) ISP will be updated by nurse when hospice assumes care of resident. 4) AL Dir or Designee will audit 3 records of residents on hospice weekly for 4 weeks 5) Finding will be submitted to QA for analysis and recommendations
Standard #:	22VAC40-73-450-E
Description:	Based on record review and staff interview, the facility failed to ensure the individualized service plan (ISP) shall be signed and dated by the licensee, administrator, of his designee, and by the resident or his legal representative. The requirements shall also apply to reviews and updates of the plan for two of four residents. Evidence: 1. During the remote renewal inspection, a review of resident #1's individualized service plan (ISP) dated by facility staff on 3-3-20 and submitted on 6-10-20 and 6-12-20 did not include the resident's signature and date or the resident's legal representative's signature and date. 2. A review of submitted individualized service plan for resident #3, noted the plan was updated by facility staff on 9-13-19, however, the resident and/or the resident's legal representative's signature and date is not documented. 3. Staff #1 acknowledge residents ISPs did not meet the regulation requirement.
Plan of Correction:	1) ISP was sent to Resident/Responsible Party on 6/25/2020. Nurse will review ISP with resident/responsible party and request signed copy be returned to facility. 2) AL Director/designee will conduct 100% review of all ISP?s to ensure they have been reviewed with resident/responsible party and signed and dated. 3) Social Worker will maintain log of date ISP reviewed and signed. 4) Dir of AL or Designee will review log and audit weekly for 4 weeks and then monthly for 3 months. 5) Outcome of audit will be reviewed by QA for analysis and recommendations.
Standard #:	22VAC40-73-470-A
Description:	Based on record review and staff interview, the facility failed to ensure, either directly or indirectly, that the health care service needs of two of four residents were met. Evidence: 1. During the remote renewal inspection, a review of resident #2's physical examination report signed by the physician on 5-1-19 and submitted to the inspector on 6-16-20 noted "PT/OT as needed to maintain strength to balance". Resident #2's date of admission documented as 5-21-19. a. A review of the individualized service plan dated by resident #2's representative on 3-7-20, did not document PT/OT services. The individualized service plan submitted noted need identified dated 5-29-19 and updated 2-28-20 noted therapy services "does not need". The document did not document a date achieve or discharge date from occupational therapy (OT)/ physical therapry (PT) services. Staff on 6-17-20 unable to confirm physician's order for services was received. 2. A review of resident #3's individualized service plan (ISP) submitted on 6-10-20 did not include the resident's need for physical and occupational therapy noted in the "Progress Note" electronically signed and dated 8-8-19, and submitted for review on 6-10-20 and 6-12-20. a. The individualized service plan signed resident #3 and dated 8-12-19 documented need for home-health service, however, the document did not include OT/PT services, it did include home-health services for skilled nursing. Staff on 6-16-20 not able to confirm resident's receipt of services per the physician's order dated 8-12-19.
Plan of Correction:	1) Resident #2 and 3, ISP was updated to reflect all services that they are receiving. 2) AL Director/designee will conduct 100% review of all ISP?s to ensure they have been reviewed with resident/responsible party and signed and dated. 3) Social Worker will maintain log of date ISP reviewed and signed. 4) Dir of AL or Designee will review log and audit weekly for 4 weeks and then monthly for 3 months. 5) Outcome of audit will be reviewed by QA for analysis and recommendations.
Standard #:	22VAC40-73-650-B
Description:	Based on record review and staff interview, the facility failed to ensure physician or other prescriber orders, both written or oral, for administration of all prescription and over-the-counter medications and dietary supplements shall include all of the required information for three of four residents. Evidence: 1. During the remote renewal inspection, a review of the submitted physician's order dated 5-7-20, for resident #1 did not include diagnosis, condition, or specific indications for the following drug and/or supplement: Tylenol, Allopurinol, Melatonin and Seroquel. 2. A review of the submitted physician's order dated 5-7-20, for resident #2 did not include diagnosis, condition, or specific indications for the following drug and/or supplement: Seroquel and Glucosamine/Chondroitin. 3. A review of the submitted physician's order dated 5-7-20, for resident #4 did not include diagnosis, condition, or specific indications for the following drug and/or supplement: Lasix, Glucotrol, Nitroglycerin patch, Ocusoft lid scrub pads, Basaglar- Kwick pen and Glucerna. 4. Staff #1 acknowledged the documents did not include all required information on 6-16-20.
Plan of Correction:	1. Resident #1: Provider contacted to clarify diagnosis, indication or conditions for use of Tylenol Allopurinol, Melatonin and Seroquel; #2: Provider contacted to clarify diagnosis, indication or conditions for use; #4 Provider contacted to clarify diagnosis, indication or conditions for use Lasix, Glucotrol, Nitroglycerin Patch, Ocusoft lid scrub pads, Basaglar-Kwick pen and Glucerna 2. Nurse designees will complete 100% audit of all current orders for all medications will be done to ensure that the diagnosis, condition or specific indications are included. 3. Nurses will be required to review new medication orders to confirm orders contain diagnosis, condition or specific indication for use. 4. AL Director/Designee will review 5 residents charts for the next 4 weeks then monthly for 3 months to ensure that all medication orders have DX 5. Outcome of audits will be reported to QAPI Committee
Standard #:	22VAC40-73-650-C
Description:	Based on document review and staff interview, the facility failed to ensure physician's or other prescriber's oral orders shall be reviewed and signed by a physician or other prescriber within 14 days. Evidence: 1. During the remote renewal inspection, a review of the submitted physician order for resident #1 for Seroquel was written by facility staff on 4-25-20. However, a review of the document noted the physician signed and dated the document on 5-20-20. 2. Staff acknowledged document not signed in 14 days per the regulation.
Plan of Correction:	1) Physician issued new order for Seroquel (signed & dated) Resident #1. 2) 100% audit will be done of all current orders to ensure signatures obtained within 5-7 business days 3) Schedule established with clinic physician to sign orders. Nursing will deliver orders to physician and retrieve the following day. 4) Task will be added to the nurse?s Shift to Shift task sheet. AL Dir/Designee will verify that the task was complete by ensuring the nurse has signed off. 5) Director or Designee will audit 5 charts weekly for 4 weeks to ensure that all physician orders are signed in a timely manner and report out in QA for analysis and recommendations.