VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Harmony at Spring Hill
8350 Mountain Larkspur Drive
Fairfax, VA 22079
(571) 348-4970

Current Inspector: Amanda Velasco (703) 397-4587

Inspection Date: June 17, 2020 , June 18, 2020 and June 19, 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 BUILDING AND GROUNDS 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. 63.2 Licensure and Registration Procedures 63.2 Facilities and Programs.. 22VAC40-90 Background Checks for Assisted Living Facilities 22VAC40-90 The Sworn Statement or Affirmation 22VAC40-90 The Criminal History Record Report 22VAC40-80 THE LICENSE. 22VAC40-80 THE LICENSING PROCESS.

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 6/17/20 and concluded on 6/19.20. The administrator was contacted by telephone to initiate the inspection. The administrator reported that the current census was 33. The inspector emailed the administrator a list of items required to complete the inspection. The inspector reviewed three resident records, three staff records, medication administration records, local fire and health inspections, and other documentation submitted by the facility to ensure documentation was complete. Information gathered during the inspection determined non-compliance with applicable standards or law, and violations were documented on the violation notice issued to the facility.

Violations:

Standard #:	22VAC40-73-650-A
Description:	Based on documentation, the facility failed to ensure that medications are not started, changed, or discontinued without a valid order from a physician or other prescriber. Evidence: Resident #3's medication administration record (MAR) was reviewed during the inspection. Resident #3's record contained an order for Vitamin D3, dated 4/7/20. The order called for the resident to receive Vitamin D3 daily for eight weeks. The MAR documented that the Vitamin D3 was not administered on 5/28/20 or 5/29/20, as a note states that the order was stopped. Resident #3's Vitamin D3 was administered on 5/30/20 and 5/31/20. Vitamin D3 was not administered to Resident #3 during the month of June. The administration of the resident's Vitamin D3 was stopped before it had been given for eight weeks.
Plan of Correction:	Resident #3's physician was notified of non-compliance of the medication order. There were no adverse effects. Med Techs, (RMAs), Wellness Nurses, (LPNs), and Healthcare Director, (HCD), or designee will verify all new orders and confirm that the end dates and special instructions are entered correctly into the Electronic Medication Administration system. The Healthcare Director, (HCD), Executive Director, (ED), Harmony Square Director, (HSD), or designees will perform daily care meetings to verify accuracy and compliance of orders. Nursing staff in-serviced on medication management. The Executive Director, (ED), or designee is responsible for confirming the implementation and ongoing compliance with the components of this Plan of Correction.
Standard #:	22VAC40-73-680-D
Description:	Based on documentation, the facility failed to ensure that medication is administered in accordance with the physician's instructions and consistent with the standards of practice outlined in the current registered medication aide curriculum approved by the Virginia Board of Nursing. Evidence: Resident #1's medication administration record (MAR) was reviewed during the inspection. Resident #1's record contained an order for Simethicone, dated 8/14/19. The order called for Resident #1 to receive Simethicone two times per day. The MAR indicated that Resident #1's Simethicone was not administered on 5/12/20 (5 PM administration). The note on the MAR stated that the medication was "pending." Resident #2's medication administration record (MAR) was reviewed during the inspection. Resident #2's record contained an order for Alprazolam, dated 4/7/20. The order called for Resident #2 to receive the medication every eight hours PRN (as needed) for anxiety. The MAR documented that Resident #2 was administered Alprazolam at 8:08 AM on 5/7/20. The MAR also documented that Resident #2 was administered Alprazolam at 10:55 AM on 5/7/20. Eight hours had not elapsed between the two doses, as required by the order.
Plan of Correction:	Resident #1's physician was notified of non-compliance of the medication order. There were no adverse effects. Med Techs, (RMAs), Wellness Nurses, (LPNs), and Healthcare Director, (HCD), or designee will confirm that all medications are re-ordered timely to prevent administration delays. Weekly cart audits shall be completed to ensure physicians instructions are followed. Staff were re-educated on proper and thorough MAR documentation and reordering of medications. The Healthcare Director, (HCD), Executive Director, (ED), Harmony Square Director, (HSD), or designees will perform daily care meetings to confirm accuracy and compliance. Resident #2's physician was notified of non-compliance of the medication order. There were no adverse effects. Staff were re-educated on proper and thorough MAR documentation. The Healthcare Director, (HCD), Executive Director, (ED), Harmony Square Director, (HSD), or designees will perform daily care meetings to confirm accuracy and compliance. The Executive Director, (ED), or designee is responsible for confirming implementation and ongoing compliance with the components of this Plan of Correction and addressing and resolving variances that may occur.