VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Commonwealth Memory Care at Chesapeake
130 Great Bridge Boulevard
Chesapeake, VA 23320
(757) 436-2109

Current Inspector: Donesia Peoples (757) 353-0430

Inspection Date: May 18, 2021 , May 19, 2021 and May 20, 2021

Complaint Related: No

Areas Reviewed:

22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-90 The Sworn Statement or Affirmation

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 May 18, 2021 and concluded on May 20, 2021. The Executive Director was contacted by telephone to initiate the inspection. The Executive Director reported that the current census was 48. The inspector emailed the Executive Director a list of items required to complete the inspection. The inspector reviewed 3 resident records, 3 staff records, health and fire inspections, fire and emergency drills, healthcare oversight, pharmacy oversight, activities calendar, staff schedules, menus submitted by the facility to ensure documentation was complete. 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 #:	22VAC40-73-650-B
Description:	Based on record review and discussion, the facility failed to ensure physician?s orders identified the diagnosis, condition, or specific indications for administering each drug. Evidence: 1. Resident #1?s physician?s orders dated 04-08-2021 did not identify the diagnosis, condition, or specific indications for administering Bupropion and Mirtazapine. 2. Staff #1 confirmed during discussion that the diagnosis, condition, or specific indication for administering the aforementioned drugs were not included in the physician?s order.
Plan of Correction:	Resident Care Director and/or designee to review physician orders monthly for missing diagnosis and update accordingly. Resident #1?s physician orders have been updated to reflect diagnosis for the 2 medications sighted on this notice.
Standard #:	22VAC40-73-720-A
Description:	Based on record review and discussion, the facility failed to ensure Do Not Resuscitate (DNR) Order was included on the individualized service plan (ISP). Evidence: 1. Resident #2?s hospice ?Plan of Care Update Report? dated 02-24-2021 documented a DNR order was in place; however, the DNR was not documented on the resident?s ISP dated 12-30-20. 2. Staff #1 confirmed the DNR orders were not included on the ISP.
Plan of Correction:	Resident Care Director and/or designee will ensure that each ISP is reviewed and updated every six months or if there is a change in the resident condition to include the assessed needs per UAI. Resident #2?s ISP was updated to reflect assessed needs. Executive Director or designee will complete random monthly audit of a minimum of 5 Comprehensive ISP?s to ensure ongoing compliance.
Standard #:	22VAC40-90-30-C
Description:	Based on record review and discussion, the facility failed to ensure any person making a materially false statement on the sworn statement shall be guilty of a Class 1 misdemeanor. Evidence: 1. Staff #2 and Staff #3`s sworn statements documented ?No? on the question ?Have you ever been convicted of a law violation(s) but excluding offenses committed before your eighteenth birthday that were finally adjudicated in a juvenile court or under a youth offender law?? 2. Staff #2?s and staff #3?s Criminal History Record documented convictions. 3. Staff #1 confirmed the aforementioned staffs? sworn statements contained materially false statement contradicting the ?Criminal History Request Response? received.
Plan of Correction:	Business Office Manager and/or designee to review all sworn disclosure statements upon hiring, and again after requesting criminal history record. Do to such a huge staffing challenge in the healthcare industry, staff #2 and #3 were given another sworn disclosure to complete and their criminal backgrounds processed again. They both were counseled on the verbiage of the sworn disclosure statement.