VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Valley View Retirement Community
1213 Long Meadows Drive
Lynchburg, VA 24502
(434) 237-3009

Current Inspector: Jennifer Stokes (540) 589-5216

Inspection Date: Aug. 14, 2020

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 STAFFING AND SUPERVISION 22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-80 COMPLAINT INVESTIGATION.

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 complaint inspection was initiated on 08/14/2020 and concluded on 09/08/2020. A complaint was received by the department regarding allegations in the areas of staffing and supervision and resident care. The Administrator was contacted by telephone to conduct the investigation and a virtual inspection was conducted on 08/14/2020 to initiate the complaint. The licensing inspector emailed the Administrator a list of documentation required to complete the investigation. The evidence gathered during the investigation supported one of the allegations of non-compliance with standards or law, and violations were issued. Any violations not related to the complaint but identified during the course of the investigation can be found on the violation notice.

Violations:

Standard #:	22VAC40-73-680-D
Complaint related:	Yes
Description:	Based on resident record review, staff interviews and virtual inspection, the facility failed to ensure that medications were administered in accordance with physician?s or other prescriber?s instructions. EVIDENCE: 1. The record for resident 1 contained a physician?s order, dated 03/03/2020, for MIRTAZAPINE 5X6 15 MG TAB RAPDIS GIVE 1 TAB BY MOUTH EVERY DAY FOR DEPRESSION. 2. The July 2020 and August 2020 medication administration records (MARs) for resident 1 contained initials at 9PM for every day from 07/11/2020 through 08/13/2020 indicating that 34 does of Mirtazapine 5X6 15 MG Tab Rapdis were given by physician?s order. 3. During virtual inspection of the night time medication cart on 08/14/2020 at 11:40 AM, it was revealed by staff 3 that the prescribed Mirtazapine for resident 1 was in a box and the label contained the following information: a quantity of 30 tablets, fill date of 07/05/2020, and order/RX number of ?R91361584? and contained a written date of 07/11/2020 on inside flap of the box that the box was opened by staff. Staff 3 verified that the box was opened on 07/11/2020. The box still contained 12 tablets in a unit-dose packaging. However, if the medication had been given as ordered and indicated on the MARs there wouldn?t have been any medication left. 4. Interview with Collateral 1 revealed that there were 30 tablets of MIRTAZAPINE 5X6 15 MG TAB RAPDIS delivered to the facility on 07/06/2020 for resident 1 and that the medication is packaged ?inside a box with unit-dose packaging?. 5. The document ?PRESCRIPTIONS DELIVERED TO VALLEY VIEW RETIREMENT? showed on 07/06/2020 at 13:09:45 30 tablets of MIRTAZAPINE 5X6 15 MG TAB RAPDIS ?ORDER # R91361584? were delivered to the facility for resident 1. The document ?Order Status Display Filling Company : 9 Omnicare of Lynchburg? showed MIRTAZAPINE 5X6 15MG TAB ?Rx #: R91361584? was filled on 07/05/2020 and a quantity of 30 was delivered to the facility at 1:09PM on 07/06/2020 for resident 1. Both documents indicate that only 30 doses of the medication was delivered to the facility on this date.
Plan of Correction:	Under the EVIDENCE Description, I will agree #1 and #2 is correct. However, under Description #3, #4 & #5, I believe three of my staff who have given a written statement that there was another blister pack of MIRTAZAPINE 15MG medication, regular tab/not rapdis. Staff 3 and RMA- Team Lead physically saw the blisterpack and another RMA was in the Med Room when they were discussing this subject. Even though Collateral 1 advised from what he could see in his system there was only 30 tabs of rapdis sent in July; however, he also advised Staff 3 that "anything was possible". I also will say that the box of MIRTAZAPINE sent on 7/06/20, was opened 7/11/20. Three RMAs gave this medication other than the Team Lead from the opening date of the box thru the 9th of August. The blister-pack disappeared supposedly during this time. The blisterpack was regular MIRTAZAPINE 15MG Tabs, not rapdis. However, Staff 3 had called the pharmacist to make sure there would not be any harm to the resident. I believe, even though you say I cannot prove it, the possibility exists that the persons responsible for the complaint retaliated to affect the Team Lead with their vindictive behavior. I feel personally that, if Staff 3 said she physically observed the blisterpack, she did! There is an almost 16-year association with this person; and, up until recently, we had only ever received 1 or 2 complaints in that period of time. I also believe the Team Lead as well. There again, as Collateral 1 advised, "anything is possible". In conclusion, with reorganization of our staff, appointing a Full-Time Floor Supervisor, additional medication monitoring and more one-on-one training with the RMAs, feel we have made the play ensuring that medications will be administered in accordance with the physician's or other prescriber's instructions.