VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Brookdale Harrisonburg
2101 Deyerle Avenue
Harrisonburg, VA 22801
(540) 574-2982

Current Inspector: Jessica Gale (540) 571-0358

Inspection Date: July 15, 2020

Complaint Related: No

Areas Reviewed:

22VAC40-73 RESIDENT CARE AND RELATED SERVICES

Comments:

A monitoring inspection was conducted by licensing staff using an alternative remote protocol necessary due to a state of emergency health pandemic declared by the Governor of Virginia. A self-reported incident was received by the department on 07/15/20 relating to the allegation of medication mismanagement. The ED was contacted by telephone to conduct the investigation. The licensing inspector emailed the ED a list of documentation required to complete the investigation. The evidence gathered during the investigation supported the self-reported incident of medication mismanagement and 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 #:	22VAC40-73-450-C
Description:	Based upon review of resident A's record, the facility failed to ensure all assessed needs are included on the initial Individualized Service Plan (ISP). EVIDENCE: 1) The initial plan for resident A does not include the inability to use the call bell system. a. Resident A resides in the memory care unit. 2) The UAI indicates appropriate behavior for resident A. The ISP indicates abusive,aggressive and disruptive behavior. 3) The section of the UAI that addresses walking is not completed. a. Per the ED on 07/16/20, resident A is non-ambulatory and requires assistance of two staff. This is not indicated on the ISP. 4) The ISP dated 06/24/20 does not contain a signature of the legal representative or indicate that the resident and legal representative have received a copy of the plan.
Plan of Correction:	Intensive Plan of Correction Required.
Standard #:	22VAC40-73-680-D
Description:	Based upon communication and documentation received on 07/15/20, resident A was administered another resident's medication by staff A. EVIDENCE: 1) Resident A has the following order: Oral Rinse Liquid (Cetylpyridinium Chloride)-Give 20mls by mouth every morning and bedtime. Swish and spit 20ml once at 8:00am and again at 8:00pm 2) Documentation on 07/15/20 indicates resident A was administered 20mg Rispradol Solution by staff A on 07/14/20 at 8:15pm. 3) Resident was sent to ER for evaluation, admitted and returned to the facility on 07/16/20.
Plan of Correction:	Intensive Plan of Correction Required.