VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Candis Assisted Living
1619 Hanover Ave
Roanoke, VA 24017
(540) 343-8640

Current Inspector: Angela Marie Swink (276) 623-6575

Inspection Date: Dec. 9, 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 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS Article 1 Subjectivity 32.1 Reported by persons other than physicians 63.2 General Provisions. 63.2 Protection of adults and reporting. 63.2 Licensure and Registration Procedures 63.2 Facilities and Programs.. 22VAC40-90 Background Checks for Assisted Living Facilities 22VAC40-90 The Sworn Statement or Affirmation 22VAC40-90 The Criminal History Record Report 22VAC40-80 THE LICENSE. 22VAC40-80 THE LICENSING PROCESS. 22VAC40-80 SANCTIONS.

Technical Assistance:

To ensure that the facility had a thorough understanding of standards, the LI and the Administrator had a discussion regarding standard 440 D.

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 12/8/2020 and concluded on 12/11/2020. The Administrator was contacted by telephone to initiate the inspection. The Administrator reported that the current census was 15. The inspector emailed the Administrator a list of items required to complete the inspection. The inspector reviewed 2 resident records, 2 staff records, recent staff schedule, health care oversight, fire inspection, and past three fire drills submitted by the facility to ensure documentation was complete. The LI and the Administrator had a discussion regarding standard 650 B. 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 #:	22VAC40-73-210-F
Description:	Based on staff record review and staff interview, the facility failed to ensure all staff had at least four hours of residents? mental impairments training annually. EVIDENCE: 1. The record for staff 1, date of hire 03/16/1990, did not contain documentation that staff 1 had received 4 hours of annual residents? mental impairments training for the training year 03/16/2019 through 03/15/2020. 2. Interview with staff 3 confirmed that staff 1 had not received 4 hours of residents? mental impairments training.
Plan of Correction:	Staff member completed required Mental Health Training. New Administration in community. Administrator audited Employee training records with training scheduled and completed. Training requirements implemented for new hires and prescheduled for up coming training year. Administrator will complete monthly overview to ensure training needs are provided and completed.
Standard #:	22VAC40-73-320-A
Description:	Based on resident record review, the facility failed to ensure that physical examinations were completed as required prior to a resident?s admission. EVIDENCE: 1. The ?REPORT OF RESIDENT PHYSICIAL EXAMINATION? for resident 1, dated 09/01/2020, showed that the resident is allergic to Seroquel; however, the document does not include a description of the resident?s reaction to Seroquel.
Plan of Correction:	H&P corrected to indicate Allergic reaction is Unknown. Audit of resident records completed to ensure all allergic reactions are indicated or documented as unknown if applicable. Administrator or desgnee will review all new admits to ensure Allergies with reactions are provided. Quarterly reviews to follow up to ensure reactions are in place at tie of review.
Standard #:	22VAC40-73-450-C
Description:	Based on resident record review and staff interview, the facility failed to ensure that the Individualized Service Plan (ISP) addressed all of the identified needs. EVIDENCE: 1. The private pay Uniform Assessment Instrument (UAI) for resident 1, dated 10/24/2020, showed the resident needs mechanical help with bathing, stairclimbing and mobility. The ISP, dated 10/24/2020, does not include that the resident needs mechanical help with bathing, stairclimbing and mobility. 2. Interview with staff 3 confirmed that resident 1 does need mechanical help with bathing, stairclimbing and mobility. 3. The ?REPORT OF RESIDENT PHYSICIAL EXAMINATION? for resident 1, dated 09/01/2020, showed that the resident is allergic to Seroquel. The ISP, dated 10/24/2020, for resident 1 does not show that the resident is allergic to Seroquel.
Plan of Correction:	Administrator or designee will review all ISPs within 72 hours of admission for accuracy to reflect resident?s needs. Administrator, designee will audit ISPs quarterly at a minimum to ensure that all current resident needs and services are reflected on their ISP. ISP for Resident updated with needs and services reflected.
Standard #:	22VAC40-73-640-A
Description:	Based on record review and staff interview, the facility failed to implement methods to ensure that each resident?s prescription medications ordered for the resident are filled in a timely manner and that medication orders were accurately transcribed to the medication administration record (MAR) within 24 hours of receipt of a new order. EVIDENCE: 1. The record for resident 2 contained a physician?s order, dated 12/03/2020, for ?Tylenol 1000mg 1 Tab every 8 hrs PRN?. The December 2020 MAR for resident 2 did not contain documentation that ?Tylenol 1000mg 1 Tab every 8 hrs PRN? was transcribed to the MAR as of inspection on 12/11/2020. 2. The facility?s current medication management policy shows ?2. When a physician?s order is received for a new medication/treatment, fax the order to the pharmacy, initialing and noting on the order the date and time it was faxed. Order should then be placed in the resident?s medical chart flagged until the medication is received by the pharmacy and reviewed. Any new order should be inputted into the Pharmacy Log? and ? 5. When a new medication ordered by a physician is received from the pharmacy, Med Aide should ensure that the order has been entered in the electronic/paper system matches that on the medication label EXACTLY. If these do no match, call the Resident Care Director for further instructions. a) Verification that new orders or change order have been accurately transcribed onto the MAR shall occur within 24 hours of receipt of the order.?. 3. Interview with staff 3 confirmed that the order was not available at the facility and the order was not transcribed to the MAR.
Plan of Correction:	Community was able to provide resident with ordered prn medication by use of prn order currently on record by use of change of direction sticker. Current prn order from physcain uploaded into system and rejected at pharmacy level for missing quanity to be filled. Community contacted physcian at time of inspection waiting for physcian confirmation. Administrator requesting 2 step review to be in place going forward. 2 step review consists of RMA/LPN/desgnee to upload new physcians orders into EMAR system after initial review, Administrator will be alerted thru EMAR system of new order, Administrator /or designee to complete 2nd and final review of new order approving or rejecting order as applicable. Orders rejected do not become part of the current regeime providing community time to re-work order with physcians as needed to receive further information or verification as needed. Commmunity will continue to follow medicationn managment plan, complete daily EMAR audits ensuring all medication available to be administred as orders indicate. RMA/LPN or designee to complete weekly reviews of EMAR/Medications and 2x month complete POS/MAR/to cart audits. All audits to be signed by aduditor, with documentation of findings noted.Completed audits will be filed and kept for record within binders located in Administrator office.
Standard #:	22VAC40-73-650-A
Description:	Based on resident record review and staff interview, the facility failed to obtain a valid order from a physician or other prescriber prior to changing a treatment. EVIDENCE: 1. The record for resident 1 contained a signed physician?s order, dated 10/09/2020, ?OXYGEN AT 3L/MIN VIA NASAL CANNULA AT BEDTIME?. 2. Interview with staff 3 revealed that resident only uses oxygen PRN and not every night as prescribed; however, staff 3 could not provide a signed physician?s order stating that oxygen for resident 1 is prescribed PRN at bedtime.
Plan of Correction:	Community had order dated 10-2020 that indicated Oxygen to be used NON CONTINOUSLY from VA Center. Community review all veterans medication with case manager monthly however, copy of order did not have physcains signature. Community did obtain signed order to indicate PRN- non continous use of O2. New order obtain with Noncontinous use, resident able to put on and take off at will. Order to be added to POS as a informational order for team. Daily sign off for monitoring not initiated.
Standard #:	22VAC40-73-650-B
Description:	Based on resident record review, the facility failed to ensure that physicians or other prescriber orders for administration of all prescription and over-the-counter medications and dietary supplements included the diagnosis, condition or specific indications for administering each drug. EVIDENCE: 1. The record for resident 2 contained two signed physician?s orders, dated 12/03/2020, for ?Tylenol 1000mg ? 1 Tab every 8hrs PRN? and ?Amox 500 mg ? Take 1 Tab TID until gone?. These physician?s orders did not identify the diagnosis, condition or specific indications for administering each of these drugs.
Plan of Correction:	Community received initial physcians order for resident that contained specific indications for use. Community identified resident was allergic to initial medication MD notified new orders required and obtained. Orders were accompied by a physcians note indicating RX for pain and infection - note had nurse verification that orders were tylenol and Amoxicillian. LI did not accept for clear specification. Administrator requesting 2 step review to be in place going forward. 2 step review consists of RMA/LPN/desgnee to upload new physcians orders into EMAR system after initial review, Administrator will be alerted thru EMAR system of new order, Administrator or designee to complete 2nd and final review of new order approving or rejecting order as applicable. Orders rejected do not become part of the current regeime providing community time to re-work order with physcians as needed to receive further information or verification as needed. . Commmunity will continue to follow medicationn managment plan, complete daily EMAR audits ensuring all medication available to be administred as orders indicate. RMA/Lpn to complete weekly reviews of EMAR/Medications and 2x month complete POS/MAR/to cart audits. All audits to be signed by aduitor, with documentation of findings noted.Completed audits will be filed and kept for record within binders located in Administrator office.
Standard #:	22VAC40-73-680-E
Description:	Based on resident record review, the facility failed to ensure that treatments ordered by a physician or other prescriber were documented and maintained in the resident?s record. EVIDENCE: 1. The record for resident 1 contained a signed physician?s order, dated 10/09/2020, ?OXYGEN AT 3L/MIN VIA NASAL CANNULA AT BEDTIME?. 2. The record for resident 1 does not contain documentation of how staff is monitoring the usage of oxygen by the resident. 3. Interview with staff 3 confirmed that there is no documentation of usage of oxygen by the resident.
Plan of Correction:	New order obtain with Noncontinous use, resident able to put on and take off at will. Order to be added to POS as a informational only with no sign off by team required.
Standard #:	22VAC40-73-680-I
Description:	Based on resident record review and staff interview, the facility failed to ensure that all medication administration records (MARs) contained initials of direct care staff administering the medications, date and time given, and any medication errors or omissions. EVIDENCE: 1. The November 2020 MAR for resident 1 did not include the date, time given and initials of staff administering the following 9:00 PM scheduled medications on 11/10/2020 and 11/18/2020: Acetaminophen 500MG, Atorvastatin 10MG, Benztropine Mesylate 1MG, Carbidopa-Levodopa 25MG-100MG, Divalproex Sodium ER 500MG, Gabapentin (C5) 300MG, Latanoprost 0.005% drops, Levetiracetam 1000MG, Mi-Acid 80MG, Olanzapone F/C 15MG, Polyethylene Glycol 17GM, Primidone 50MG, Refresh Tears 0.5% drops, Senexon-S 8.6MG-50MG and Tamsulosin HCL 0.4MG. The November 2020 MAR for resident 1 did not include the date, time given and initials of staff administering the following 5:00 PM scheduled medications on 11/19/2020: Acetaminophen 500MG, Carbidopa-Levodopa 25MG-100MG, Gabapentin (C5) 300MG, Omeprazole 20MG, Refresh Tears 0.5% drops and Vitamin B-12 1000MCG. The record for resident 1 did not include documentation that these medications had been administered during these times and contained no medication errors or omissions for these drugs. 2. The November 2020 MAR for resident 2 did not include the date, time given and initials of staff administering the following 9:00 AM scheduled medication on 11/15/2020 and 11/16/2020: Amlodipine Besylate 10MG. The record for resident 2 did not include documentation that these medications had been administered during these times and contained no medication errors or omissions for these drugs.
Plan of Correction:	Community has corrected EMAR for resident 1 and 2 as specified with EMAR Exception, and staff documentation. Community contacted Electronic Medication Program handler to inquire to safety alerts that were to be in place for quick identification of missed signatures or documentation for quick and immediate response by staff. Alerts were reinitiated with added step of Administrator also receiving alerts every day per administration times as follow thru to staff member initializing each medication passed. Team members will continue to utilized Communities medication managment policy and procdeures. Prior to administration of scheduled medication, team member will review EMAR dashboard to verify no exception of missed medication has been indicated. Adminstrartor will complete daily log in to EMAR to check miss meds and exceptions to verify completed without need for further follow up.
Standard #:	22VAC40-73-700-1
Description:	Based on resident record review, the facility failed to ensure a valid physician?s order for oxygen contained all the required components. EVIDENCE: 1. The record for resident 1 contained a physician?s order, dated 10/09/2020, that showed ?OXYGEN AT 3L/MIN VIA NASAL CANNULA AT BEDTIME?. The order does not contain the oxygen source.
Plan of Correction:	New order obtained to include nasal cannual as source of oxygen.All new oxygen orders will be reviewed to ensure that the order is written to include al required components. Quarterly nursing review will include review of all Oxygen orders to ensure wriitten and documented per requirements.