VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Riverside Assisted Living at Warwick Forest
860 Denbigh Blvd.
Newport news, VA 23602
(757) 886-2000

Current Inspector: Willie Barnes (757) 439-6815

Inspection Date: May 10, 2021 , May 11, 2021 , May 17, 2021 and May 18, 2021

Complaint Related: No

Areas Reviewed:

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 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS Article 1 Subjectivity 22VAC40-90 Background Checks for Assisted Living Facilities 22VAC40-90 The Sworn Statement or Affirmation 22VAC40-90 The Criminal History Record Report

Comments:

This inspection was conducted by the licensing staff using an alternate remote protocol necessary due to the state of emergency health pandemic declared by the Governor of Virginia. A monitoring inspection was initiated on 5-10-21. The administrator was contacted by telephone to initiate the inspection. The administrator reported that current census was 105. The inspector emailed the administrator a list of items required to complete the inspection. The inspector reviewed five staff records, five resident records, healthcare oversight, nutrition report, staff schedules, sworn disclosure and criminal record report and fire and emergency drills also fire and health inspections. Information gathered during the inspection determined non-compliance(s) with applicable standards or law, and violations were documented on the violation notice issued to the facility.

Violations:

Standard #:	22VAC40-73-580-D
Description:	Based on record review and staff interview, the facility failed to ensure when a resident UAI has been assessed as dependent in eating/feeding, the individualized service plan shall indicate an approximate amount of time needed for meals to ensure needs are met. Evidence: 1. On 5-13-21, resident 4?s uniformed assessment instrument (UAI) dated 2-4-21 documented eating/feeding assessed as spoon-fed. The individualized service plan (ISP) did not include the approximate amount of time needed for meals. 2.On 5-18-21, staff #1 acknowledged, the ISP did not include the approximate amount of time resident needed to spoon-fed.
Plan of Correction:	1.Resident #4?s ISP has been updated to include the approximate amount of time needed for meals. 2. Unit Manager and/or designee will perform an audit of 100% of residents requiring assistance with eating/feeding to ensure approximate amount of time needed for meals is documented on ISP. 3. The Nurse Educator will provide additional education on Individualized Service Plans and the UAI. 4. The Administrator/designee will conduct random audit of 5 Individualized service plans monthly to ensure approximate time needed for meals is documented for residents who need assistance with eating/feeding. All completed actions will be submitted to the QA Committee for analysis and recommendation.
Standard #:	22VAC40-73-640-A
Description:	Based on record review and staff interview, the facility failed to ensure it's medication management plan was followed to ensure that two of five resident's prescription medication and any over-the-counter drugs and supplements ordered for the resident are filled and refilled in a timely manner to avoid missed dosages. Evidence: 1. On 5-3-21, resident #2's April 2021 medication administration record (MAR) documented "Ensure original supplement administer 237 ml by mouth three times a day for supplement and weight loss management". The inspector's was able to see circles around various initials and the following dates: 4-22-21/ 4-23-21/ 4-26-21/ 4-27-21/ 4-28-21/ and 4-29-21. A review of the MAR's Nurse Medication Notes documented one circled date and initials on 4-26-21, Ensure was not available. No documentation was noted for the other circled dates. 2. On 5-18-21, staff #1 acknowledged the family member who supplies the supplement was not available and supplement may not have been available. 3. On 5-13-21, resident #4's April medication administration record (MAR) documented, "Magic cup-provide with lunch and dinner meals for supplement". The April 2021 MAR noted staff initials and circled dates for 4-18-21 thru 4-25-21 (1200 scheduled time). A review of the MAR's Nurse Medication Notes documented Magic cup not available on 4-19-21/ 4-20-21/ 4-22-21/ 4-24-21 and 4-24-21. 4. On 5-20-21 staff #1 acknowledged resident #4's Magic cup supplement may not have been available due to delivery source used by the facility.
Plan of Correction:	1.Resident #2 and Resident #4?s weights and labs were reviewed and no adverse events occurred from missing the supplements. 2. Unit Managers/designees will conduct a monthly review all Resident MARs to ensure that all medication is available. 3. A letter will be issued to all families providing medication to advise that all medication must be refilled within five days of replenishing date. Nurse Educator will provide reeducation on the facilities medication management plan. 4. The Administrator/Designee will do an inventory count on supplements for 3 months to ensure all medication is available. Completed actions will be submitted to the QA Committee for analysis and recommendations.
Standard #:	22VAC40-73-680-I
Description:	Based on record review and staff interview, the facility failed to ensure the medication administration record contained all required information for two of five records Evidence: (680-I.6) 1. On 5-13-21, resident #3?s April 2021 medication administration record (MAR) did not include the diagnosis, condition, or specific indications for administering the Nizoral cream. (680-I.9) 2. On 5-13-21, resident #3?s April 2021 medication administration record did not include the initials of staff person who administered resident?s Gabapentin (600 mg) at 3 pm on 4-9-21 and 4-27-21. a. Resident #3?s MAR did not include the initials of staff who place resident?s compression stocking on 49-21 and 4-10-21. The MAR did not include the initials of staff who remove/ took off the resident?s compression stocking nine (times) for the month of April 2021. 3. On 5-20-21, staff #1 acknowledged the MAR for resident #3 did not include all required information.
Plan of Correction:	1 Resident #3?s MAR was reviewed by the nurse manager/designee. The resident?s physician was notified of the missed documentation of administration. 2. A 100% audit of the MARs will be conducted by the nurse manager/designee to ensure no holes in documentation. All findings will be reported to the resident?s provider as well as the QA committee for analysis and recommendation. 3. The Nurse Educator/designee will provide additional education for the nursing staff regarding medication management and record keeping. 4. The Nurse Managers will conduct a monthly audit of all medication administration records and physician order sheets to ensure the records include all required information. All completed actions will be submitted to the QA Committee for analysis and recommendation. 6/5/021 and ongoing
Standard #:	22VAC40-73-680-K
Description:	Based on record review and staff interview, the facility failed to ensure when medication aides administer the PRN medications the facility has obtained from the resident?s physician or other prescriber a detailed order that included the exact dosage of the medication for one of five residents Evidence: 1. On 5-13-21, resident #2?s physician order sheet (May 2021) documented Voltaren gel 1%, ?apply 2 to 4 gms topically over affected joint every 6 hours as needed for pain?. 2. On 5-13-21, staff #1 acknowledged the PRN medication for resident #2 did not include the exact dosage of Voltaren to be applied.
Plan of Correction:	1. Resident #2?s MAR was reviewed by the nurse manager/designee. We have received clarification orders from the physician 2. A 100% audit will be conducted of current physician orders by the nurse manager/designee to ensure order includes the exact dosage of the medication. 3. The Nurse Managers will educate all LPNs and Medication Aides on the necessary requirements of the prescribers order. The nurse managers will perform a second check on all new orders to ensure that all components required are present. 4. The Nurse Managers/designee will conduct an audit of all physician order sheets/ Medication Administration Records monthly for three months to validate LPN/RMA compliance and understanding. All completed actions will be submitted to the QA Committee for analysis and recommendation.