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:

Complaint Related: No

Violations:

Standard #:	22VAC40-73-320-A
Description:	Based on resident record review and interview, the facility failed to ensure the physical examination included the resident?s address, phone number, and a description of the resident?s reactions to any known allergies. Evidence: 1. Resident #4?s physical examination report dated 01-24-2020 did not include the resident?s address or phone number. The physical examination report also documented the resident is allergic to Clindamycin; however, the report did not document a description of the resident's reaction. 2. Staff #1 did not provide additional attachments of the physical examination documenting the resident #4?s address, phone number, or description of the resident?s reaction to Clindamycin. 3. Staff #1 acknowledged resident #4?s physical examination did not include the aforementioned required information.
Plan of Correction:	*Registered Nurse Coordinator, Assistant Care Coordinator, and the Community Relations Director reviewed the requirements of regulation 320-A to assure a clear understanding regarding missing biographical information from the Physical Examination Form and the need for correction prior to a resident?s admission. *Resident #4 had the missing biographical information added to his Physical Examination Report. *All current resident?s Physical Examination Reports were audited to assure that all requested biographical information is included on the form with no blank areas. *All future admission Physical Examination Reports will be reviewed upon receipt to assure that all of the biographical information has been added to the form, as required.
Standard #:	22VAC40-73-450-C
Description:	Based on resident record review and interview, the facility failed to ensure the individualized service plan (ISP) included a description of identified needs based upon the uniform assessment instrument (UAI). Evidence: 1. The following ISP?s did not include a description of the residents? identified needs: A. Resident #1?s current UAI dated 02-17-2020 documented the need for mechanical and physical assistance with bathing; however, the current ISP dated 02-17-2020 did not document the type of physical assistance that is needed by staff for bathing. B. Resident #2?s current UAI dated 06-10-2020 documented the need for verbal reminders with eating; however, the current ISP dated 06-10-2020 did document the need for verbal reminds with eating. C. Resident #3?s current UAI dated 03-02-2020 documented the need for mechanical and physical assistance with transferring with the use of a gait belt and wheelchair/walker, mechanical and physical assistance with wheeling, and physical assistance cutting up meat and opening packets with eating. The current ISP dated 03-02-2020 did not include the need for a gait belt with transferring; did not include the need for and physical assistance for wheeling; or include the need for cutting up meat with eating. 2. Staff #1 acknowledged resident #1, resident #2, and resident #3?s ISP?s did not include a description of the residents? aforementioned needs.
Plan of Correction:	*Residents #1, #2, and #3 ISPs were updated to reflect the current needs identified on their UAIs *All current resident?s most recent ISPs were reviewed and updated, if necessary, to assure that the most current needs identified on the UAI are reflected on that ISP. *Moving forward, the RN Coordinator/Assistant Care Coordinator and the Director will review, at the time of signature, all updated resident ISPs will be compared with the current or updated UAI to assure that all current needs are appropriately reflected on each document.
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 02-08-2020. The orders did not include a diagnosis for the Novolog inj, Methimazole 5mg, or Pot Cl Micro 20meq. 2. Staff #1 and staff #2 acknowledged resident #1?s physician?s orders did not include a diagnosis for each drug.
Plan of Correction:	*RN Coordinator, Assistant Care Coordinator and Registered Medication Aides in-serviced on the requirement that all physician orders for over the counter and prescription medications contain the diagnosis or specific indications for administering each drug. *Resident #1 had the appropriate diagnosis or indications for administration profiled on the electronic Physician Order Sheet and are obtaining it on all written orders. *All current resident?s electronic Physician Order Sheets were audited to assure that all prescription and over the counter medications have a diagnosis or indications for administration. *At the beginning of each month, the RN Coordinator, Assistance Care Coordinator, or RMA will review all electronic Physician Order Sheets to assure that each order, carried over from the previous month, has the diagnosis or specific indications for administering each drug.
Standard #:	22VAC40-73-680-D
Description:	Based on resident record review and interview, the facility failed to ensure medications were administered in accordance with the physician's instructions. Evidence: 1. Staff #1 provided a copy of resident #1?s current signed physician?s orders dated 02-08-2020, which documented ?Novolog Inj Flexpen- Inject per S/S [sliding scale] at Dinner: 100-150= 15U; 151-200= 20U?? 2. Staff #2 stated the number of Novolog units administered are documented on the MAR under the ?Agamatrix.? Resident #1?s June 2020 Medication Administration Record (MAR) documented ?Agamatrix? blood glucose (BG) was ?161? on 06-02-2020; ?152? on 06-04-2020; and ?161? on 06-13-2020 when checked during the 4:30 PM medication administration. Staff documented 15 units of Novolog were administered to resident #1 during the 4:30 PM medication administration on 06-02-2020, 06-04-2020, and 06-13-2020; instead 20 units of Novolog per the physician?s instructions. 3. Staff #2 confirmed the number of Novolog units are documented on resident #1?s June 2020 MAR. 4. During interview, staff #1 and staff #2 acknowledged resident #1?s Novolog insulin was not administered in accordance with the physician?s instructions.
Plan of Correction:	*RN Coordinator reviewed resident #1 Novolog orders with his Provider, who then reviewed them with resident #1 and determined that he was capable of appropriate decision making and having input with regards to his insulin administration. *RN Coordinator faxed the new insulin orders for resident #1 to the pharmacy to be profiled on his eMAR. *RN Coordinator received direction on how to change the format of the insulin orders in QuickMar/eMAR to allow for the entry of ?units? of insulin given onto the eMAR. *All staff administering medications were oriented to the changes on the eMAR and resident #1 rights to have input with regards to his insulin administration. *RN Coordinator, and Assistant Care Coordinator to monitor resident #1 eMAR during weekly eMAR audits to assure that his administered Novolog is being documented correctly.