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Hills Home for Adults
1443 Commerce Avenue
Chesapeake, VA 23324
(757) 545-8797

Current Inspector: Margaret T Pittman (757) 641-0984

Inspection Date: July 22, 2020 and July 23, 2020

Complaint Related: No

Areas Reviewed:
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 EMERGENCY PREPAREDNESS
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 07-22-2020 and concluded on 07-23-2020. The Staff Person in Charge/RMA was contacted by telephone to initiate the inspection. The Staff Person in Charge/RMA reported that the current census was 41. The inspector emailed the Staff Person in Charge/RMA a list of items required to complete the inspection. The inspector reviewed 3 resident records, 3 staff records, criminal background checks and sworn disclosures of newly hired staff, staff schedules, fire drills, and the fire and health inspection reports.

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 #: 22VAC40-73-310-A
Description: Based on record review and interview, the facility failed to ensure no resident was admitted in the facility with prohibitive conditions including individuals requiring continuous licensed nursing care.
Evidence:
1. Resident #2 was admitted to the facility on 02-06-2020. Resident #2?s admission physical examination dated 01-06-2020 documented the resident required continuous licensed nursing care.
2. Staff #1 acknowledged resident #2?s aforementioned admission physical documented the prohibitive condition requiring continuous licensed nursing care.

Plan of Correction: 1. Prior to admission date, Hill' s Home for Adults will make sure that the resident coming onboard; has the proper paper work and meets all ALF requirements.
Corrected as of August 8, 2020
? Hill's Home for Adults Office Manager and Mr. Earl Hill will thoroughly revise ISP, UAI, and all physicals to make sure they meet ALF requirements.:
? Hill's Home for Adults Office Manager, along with Mr. Earl Hill will continue to make sure all residents charts are checked on a monthly basis.

Standard #: 22VAC40-73-320-A
Description: Based on record review and interview, the facility failed to ensure within the 30 days preceding admission, a person should have a physical examination by an independent physician. The report of such examination should contain the resident?s address and phone number; diagnosis or significant problems; any recommendations for care including medication, diet, and therapy; and the physician?s signature.
Evidence:
1. Resident #3 was admitted to the facility on 09-20-2019. Resident #3's admission physical examination dated 08-27-2020 did not include the resident?s address and phone number; diagnosis or significant problems; recommendations for care including medication, diet, and therapy; or the physician?s signature.
2. Staff #1 could not provide documentation of the aforementioned information that was missing on resident #3?s physical examination.
3. Staff #1 provided another physical examination for resident #3 dated 09-28-2020; however, the examination was not within 30 days preceding admission.
4. Staff #1 acknowledged resident #3?s physical examination was did not include the required information and was not completed by an independent physician within 30 days preceding admission.

Plan of Correction: 1. Prior to admission, a physical would be required dated 30 days prior to on boarding facility.
2. Hill's Home for Adults will make sure resident and representative is made aware of this policy before accepting the resident into the facility.
?Hill' s Home for Adults will make sure every documentation needed per state regulations, is submitted in a timely manner.
?Hill' s Home for Adults Office Manager and Mr. Earl Hill will continue to make sure that the required documents are in resident s charts by periodically checking charts.

Standard #: 22VAC40-73-680-D
Description: Based on record review and interview, the facility failed to ensure medications are administered in accordance with the standards of practice outlined in the current registered medication aide curriculum approved by the Virginia Board of Nursing.
Evidence:
1. According to the current Virginia Board of Nursing registered medication aide curriculum 18VAC90-60-110. Standards of practice. A medication aide shall not: Administer by subcutaneous route, except for insulin medications, glucagon, or auto-injectable epinephrine.
2. Resident #2?s current signed physician?s orders dated 07-21-2020 (original order dated 02-27-2020) documented ?Risperdal Consta 50mg/2 mL IM Syringe- 50 Syringe(s) Intramuscular Once a day,, Thursday,, Every 2 week (s) (dx, schizophrenia).?
3. Resident #2?s July 2020 Medication Administration Record (MAR) documented the Risperdal 50mg/2 mL injections were administered by staff #1 (Registered Medication Aide) on 07-02-2020 and 07-16-2020.
4. Staff #1 stated staff #6 (LPN) administered the Risperdal 50mg/2 mL injection to resident #2; however, there was no documentation on the July 2020 MAR indicating the injection was administered by staff #6.
5. When asked to provide documentation verifying staff #6 administered the Risperdal 50mg/2 mL injection to resident #2, staff #1 provided a copy of the staff ?Nurse?s Notes? dated 07-06-2020 and 07-21-2020. Staff #6 documented on the ?Nurse?s Notes? ?Resident [resident #2] received his biweekly injection of Risperdal 50mg/2 mL?? There was no documentation in the ?Nurse?s Notes? stating that staff #6 administered the injection. The ?Nurse?s Notes? were also dated four days after each Risperdal injection was administered per the July 2020 MAR.
6. Staff #1 was not able to provide additional documentation verifying that staff #6 administered the Risperdal 50mg/2 mL injection to resident #2.
7. Additionally, staff #6 was listed as "off? on the July 2020 staff schedule dated 07-02-2020 and 07-16-2020 and the staff timesheets confirmed the staff #6 did not work on 07-02-2020 or 07-16-2020.
8. Staff #1 acknowledged she signed resident #2?s July 2020 MAR which documented the administration of the Risperdal 50mg/2 mL injection.

Plan of Correction: 1. Hill's Home for Adults will make sure that the LPN/ Nurse is made aware of the injection dates and that they are completed on the assigned date .
2. Hill's Home for Adults Office Manager and Earl Hill will make sure LPN/ Nurse provide adequate documentation in MAR and in the resident's chart, as well as clocking in when giving injection and documentation, per doctor's order.
? Mr. Hill and Office Manager will frequently check with LPN/ Director of Nursing when injections are due to make sure injections are documented on MAR as well as charted in resident's chart by LPN.
? Hill' s Home for Adults Director of Nursing, along with Mr. Earl Hill will continue to make sure the proper steps are taken and followed by state guidelines.

Standard #: 22VAC40-73-970-A
Description: Based on record review and interview, the facility failed to ensure the fire and emergency evacuation drill frequency and participation was in accordance with the current edition of the Virginia Statewide Fire Prevention Code (13VAC5-51). The drills required for each shift in a quarter should not be conducted in the same month.
Evidence:
1. The July 2020 staff schedules documented the facility has three shifts from 7:00 AM to 3:00 PM, 3:00 PM to 11:00 PM, and 11:00 PM to 7:00 AM.
2. Staff #1 provided a copy of the facility?s ?Record of Required Fire and Emergency Evacuation Drills.? The following quarterly fire and emergency evacuation drills were conducted:
A. On 04-01-2020 at 10:00 AM; 04-06-2020 at 8:00 AM; 04-11-2020 at 10:30 AM.
B. On 05-01-2020 at 11:00 AM; 05-27-2020 at 10:00 AM.
C. On 06-01-2020 at 11:00 AM; and 06-27-2020 at 10:00 AM.
3. The facility did not have documentation of a drill being conducted during the 3:00 PM to 11:00 PM shift or 11:00 PM to 7:00 AM shift during the months of April, May, or June 2020.
4. Staff #1 acknowledged the facility did not conduct a fire and emergency evacuation drill in accordance with the current edition of the Virginia Statewide Fire Prevention Code during the 3:00 PM to 11:00 PM shift or 11:00 PM to 7:00 AM shift for the months of April, May, or June 2020.

Plan of Correction: 1. Hill's Home for Adults will make sure fire drills are completed and logged in on each shift by Shift Supervisor.
? Hill's Home for Adults Office Manager and/or Mr. Earl Hill will sign off on all drills for each shift.
? Hill's Home for Adults Office Manager alongside Mr. Earl Hill and Shift Supervisor (Med Tech) would each be responsible to complete fire drills during their scheduled shift time, as well as documenting in the fire drill book.

Standard #: 22VAC40-90-40-B
Description: Based on staff record review and interview, the facility failed to obtain a criminal history record report on or prior to the 30th day of employment for each employee.
Evidence:
1. Staff #1 provided a list of newly hired staff with the staff?s date of hire, which included staff #5 (date of hire 03-14-2020).
2. Staff #5?s criminal history record report dated 03-03-2020 documented ?Transaction is being processed.? The report did not include the results of the criminal background report from the Virginia State Police.
3. Staff #1 could not provide documentation of an additional criminal history record report obtained on or prior to the 30th day of staff #5?s employment.
4. Staff #1 stated ?We never received the criminal background report for staff #5.?

Plan of Correction: 1. Hill's Home for Adults Office Manager will make sure that prior to employment all
documentation required for employment is completed prior to start of employment as per state policy.
? Hill 's Home for Adults Office Manager will make sure that the required documentation is in staff's chart before the start date of employment.
?Hill's Home for Adults Office Manager alongside Mr. Earl Hill will continue to follow state protocol to ensure that those required documents are in every staff members chart PRIOR to start date and periodically auditing staff charts.

Disclaimer:
This information is provided by the Virginia Department of Social Services, which neither endorses any facility nor guarantees that the information is complete. It should not be used as the sole source in evaluating and/or selecting a facility.

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