VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Grayson House
110 Bedwell Street
Independence, VA 24348
(276) 773-3525

Current Inspector: Crystal Mullins (276) 608-1067

Inspection Date: Oct. 23, 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

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 monitoring inspection was initiated on 11/23/2020 and concluded on 11/23/2020. The person in charge was contacted by telephone to initiate the inspection. The person in charge reported the census to be 9. The inspector emailed the person in charge a list of items required to complete the inspection. The inspector reviewed two resident records, two staff records, the staff schedule, physician's orders, medication administration records, and fire and health inspections submitted by the facility to ensure documentation was complete. Information gathered during the inspection determined non-compliance with applicable standards or law, and one violation was documented on the violation notice issued to the facility. Please develop a plan of correction for each violation cited along with a date of correction and return a signed and dated copy back to the licensing office within 10 days of receipt (12/04/2020). If you have any questions or concerns please contact your licensing inspector at 276-608-1067. Thank you for your cooperation and assistance.

Violations:

Standard #:	22VAC40-73-680-I
Description:	Based on documentation review, the facility failed to include all required documentation on the Medication Administration Record (MAR) for one resident. EVIDENCE: 1. Resident #1 is prescribed and receives Nicotine TD 21mg/24H patch to be replaced daily. This medication was prescribed on 10/22/2020. 2. The MAR does not include the start date of this medication.
Plan of Correction:	Corrected during inspection. [sic]