VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Bickford of Virginia Beach
2629 Princess Anne Road
Virginia beach, VA 23456
(757) 821-0198

Current Inspector: Willie Barnes (757) 439-6815

Inspection Date: April 5, 2021 , April 7, 2021 , April 9, 2021 , April 13, 2021 and April 14, 2021

Complaint Related: No

Areas Reviewed:

22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES 22VAC40-73 STAFFING AND SUPERVISION 22VAC40-73 ADMISSION, RETENTION, AND DISCHARGE OF RESIDENTS 22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-73 BUILDING AND GROUNDS 22VAC40-80 SANCTIONS.

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 04-05-2021 and concluded on 04-14-2021. The Administrator was contacted by telephone to initiate the inspection. The Administrator reported that the current census was 61. The inspector emailed the Administrator a list of items required to complete the inspection. The inspector reviewed 4 resident records and staff schedules. 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 #:	22VAC40-73-70-A
Description:	Based on record review and interview, the facility failed to report to the regional licensing office within 24 hours of any major incident that has negatively affected or that threatens the life, health, safety, or welfare of any resident. Evidence: 1. The regional licensing office did not receive incident reports from the facility within 24 hours regarding the following incidents: A. Staff ?Communication Log? dated 03-20-2021 documented, ?room #305 [confirmed by staff #1 as resident #1] was found on the floor?.? Resident returned with a diagnosis of a facial laceration per the ?After Visit Summary? dated 03-20-2021. B. Resident #3?s ?Progress Notes? dated 03-17-2021 documented, ?Resident was leaning forward in [resident] w/c [wheelchair]? BFM?s [Bickford Family Member] noticed resident on the floor? Resident c/o pain in right leg which was slightly swollen?? The resident?s ?Unusual Occurrence Nursing Evaluation? form dated 03-18-2021 documented, ?x-ray revealed acute fracture.? C. Staff ?Communication Log? dated 03-04-2021 documented, ?room #311 [confirmed by staff #1 as resident #5] fell in bathroom at 10:57 PM?.? Resident returned to the facility with a diagnosis of a scalp laceration and received staples per the ?After Visit Summary? dated 03-05-2021. 2. The regional licensing office did not receive an incident report from the facility regarding the following incident: A. Staff ?Communication Log? dated 03-04-2021 documented, ?room #316 [confirmed by staff #1 as resident #6] ?upon shift arrival resident was observed on floor? Resident has laceration to left side of eye? applied steri strips to eye.? 3. Staff #1 and staff #2 acknowledged the aforementioned incidents were not reported to the regional licensing office within the required timeframes.
Plan of Correction:	*A self-initiated audit from January 1, 2021 ? March 31, 2021 was conducted, prior to the start of this inspection, and any Resident or Branch incident/accident that should have been reported, as required, was submitted to our Licensing Inspector on March 31, 2021. *Resident #6, identified during the inspection as having an event that should have been reported, did have that event reported to DSS as required. *Those designated to be in charge in the absence of the Administrator will review and acknowledge the requirement to report to the regional licensing office, within 24 hours, any major incident that has negatively affected or that threatens the life, health, safety or welfare of any resident. *The Nurse on Call will be responsible for discussing the incident with the Director and then making the initial report to DSS. The Director and Divisional Director will be copied on that email notification. *The Director, or her designee, will be responsible for submitting the final report within 7 days of the event. The Divisional Director will be copied on that email notification.
Standard #:	22VAC40-73-640-A
Description:	Based on record review and interview, the facility failed to implement its medication management plan labeled ?PP-61050-Medication Management (VA)?. Evidence: 1. The facility?s medication management plan indicates staff will communicate any issues or observations related to medication administration and will communicate issues and observations to the prescribing physician. 2. Resident #2?s March 2021 Medication Administration Record documented ?resident refused? Siltussin Syp 100/5ML on 03-11-2021 through 03-24-2021. 3. Staff #1 and staff #2 could not provide documentation that the physician was notified of the resident?s refusal on the aforementioned dates. 4. Staff #1 and staff #2 acknowledged the facility did not implement its medication management plan.
Plan of Correction:	Disputed
Standard #:	22VAC40-73-650-A
Description:	Based on record review and interview, the facility failed to ensure no medications are started or discontinued by the facility without a valid order from a physician or other prescriber. Evidence: 1. Resident #3?s hospital ?ED Provider Notes? (signed and dated by the physician on 03-08-2021) documented Cephalexin (Keflex) 500mg- take 1 cap by mouth every 12 hours for 10 days for a diagnosis of Urinary Tract Infection with hematuria. 2. Resident #3?s ?Medical Practitioner?s Orders? documented: A. Order signed and dated 03-12-2021 from a Registered Nurse (RN) documented, ?discontinue Keflex?. The order was not signed by a physician or other prescriber until 04-06-2021. B. Order signed and dated 03-29-2021 from an RN documented, ?Miconazole Nitrate powder 2%- apply small amount to buttocks 3x a day and PRN [as needed] for incontinence episodes- mix with Calmoseptine.? The order was not signed by a physician or other prescriber until 04-06-2021. C. The aforementioned orders were not labeled as an oral order. 3. Resident #3?s March 2021 and April 2021 Medication Administration Record documented: A. Cephalexin 500mg administered at 8:00 AM and 8:00 PM on 03-09-2021 through 03-11-2021, and 03-12-2021 at 8:00 AM. The staff discontinued the Cephalexin 500mg on 03-12-2021 at 1:00 PM without a physician?s order. B. Staff administered Miconazole powder 2% on 03-30-2021 through 04-06-2021. 4. Staff #1 and staff #2 acknowledged the facility started and discontinued resident #3?s aforementioned medications without a valid order from a physician or other prescriber.
Plan of Correction:	Disputed
Standard #:	22VAC40-73-680-C
Description:	Based on record review and interview, the facility failed to ensure medications are administered no earlier than one hour before and no later than one hour after the scheduled administration time. Evidence: 1. March 2021 Medication Administration Records documented the following: A. Resident #1?s Arthr Pain Gel 1% and Medihoney was scheduled to be administered at 7:00 AM, and Docusate 100mg and Prednisone 20mg was scheduled at 8:00 AM; however, the ?Med Pass Details? report documented the 7:00 AM and 8:00 AM aforementioned medications were administered at 10:14 AM on 03-08-2021. B. Resident #2?s Calcium Citrate 200-250, Asmanex 220mcg, Clopidogrel 75mg, Furosemide 20mg, Metoprolol 50mg, Multi-Vitamin, and Peg 3350 was scheduled to be administered at 8:00 AM; however, the ?Med Pass Details? report documented the 8:00 AM aforementioned medications were administered at 11:01 AM on 03-02-2021, and at 9:40 AM on 03-08-2021 and 03-11-2021. 2. Staff #1 and staff #2 acknowledged resident #1 and resident #2?s aforementioned medications were not administered no earlier than one hour before and no later than one hour after the scheduled administration time.
Plan of Correction:	* The Providers for residents #1 and #3 were notified that the medications were administered late and out of the ?hour before and hour after? administration timeframe. There were no new orders. *In an attempt to better balance the med pass between the 2 carts used for medication administration, the total resident med pass was equally divided between the AL cart to the MB cart so that the med pass can be completed within the 2-hour window for administration. * The RNC and ACC are to conduct weekly Med Audits, as outlined by Branch Support, to identify any discrepancies with the medication administration process so that there can be quick intervention. *The findings from those audits will be monitored weekly and the results reported for Divisional Review.
Standard #:	22VAC40-73-680-D
Description:	Based on record review and interview, the facility failed to ensure medications are administered in accordance with the physician's instructions. Evidence: 1. Resident #1?s signed verbal physician?s order dated 03-15-2021 documented, ?Diflucan 150mg [Fluconazole] 1 dose on day 3, 5, and 7 of ABT [antibiotic therapy] for UTI.? 2. Resident #1?s March 2021 Medication Administration Record (MAR) documented: A. ?Fluconazole Tab 150mg- Take one tablet by mouth once daily on days 3, 5, 7 (3/18, 3/20, 3/22 at 8:00 PM) of antibiotic for UTI.? B. The MAR did not document staff administered Fluconazole 150mg on 03-22-2021. C. Staff #1 and staff #2 could not provide documentation that the Fluconazole 150mg was administered to the resident on 03-22-2021. 3. Resident #4?s signed physician?s order dated 03-10-2021 documented, ?Cephalexin (Keflex) 500mg PO [by mouth] Caps- Take 1 cap by mouth twice daily for 7 days. Start date: Mar 10, 2021, end date Mar 17, 2021.? Additionally, an order dated 03-02-2021 documented, ?Avelox 400g- 1 tab PO QD [daily] x5 days for PNA.? 4. Resident #4?s March 2021 MAR documented: A. Cephalexin 500mg administered on 03-12-2021 at 5:00 PM, 03-13-2021 through 03-16-2021 at 8:00 AM and 5:00 PM, and 03-17-2021 at 8:00 AM. The resident received Cephalexin 5 out of 7 days. B. 03-17-2021 at 6:36 PM, staff ?Pass Notes? documented, Cephalexin 500mg was not administered because ?Last dose was already given. Completed.? C. Moxifloxacin 400mg [Avelox] administered on 03-05-2021 through 03-08-2021. The resident received Avelox 4 out of 5 days. D. Staff #1 and staff #2 could not provide documentation that the Cephalexin 500mg was administered to the resident on the 6th and 7th day, nor Avelox 400mg on the 5th day. 5. Staff #1 and staff #2 acknowledged the aforementioned medications for resident #1 and resident #4 were not administered in accordance with the physician?s instructions.
Plan of Correction:	*The Providers for residents #1 and #3 were notified of the missed doses for the prescribed medications. There were no new orders. *The Providers for residents #1 and #3 were notified of the missed doses for the prescribed medications. There were no new orders. *The Branch is to notify ValuMed Pharmacy of all necessary changes/corrections to administration start/stop dates and times so that those updates can be made in the QuickMar electronic administration record. *ValuMed has secured a professional courier service to deliver all medications, filled by the after-hours local pharmacy, to the Branch in a timely manner. Those medications will be inventoried onto the Backup Pharmacy Medication Receiving Log. The RNC/ACC will verify that those medications have been profiled for administration. *The RNC and ACC are to review the ValuMed Manual as a refresher on all protocols regarding the pharmacy services, processes and procedures. *The RNC and ACC are to conduct weekly Med Audits, as outlined by Branch Support, to identify any discrepancies with the medication administration process so that there can be quick intervention. *The findings from those audits will be monitored weekly and the results reported for Divisional Review.
Standard #:	22VAC40-73-930-B
Description:	Based on record review and interview, the facility failed to make and document rounds no less than every two hours for each resident with an inability to use the signaling devices, once the resident has gone to bed each evening until the resident has arisen each morning, except that rounds may be made on a different frequency if requested by the resident and agreed to by the facility. Evidence: 1. Resident #3?s most current Individualized Service Plan (ISP) dated 04-01-2021 documented, ?1 hour checks (with an identified date of 04-30-2020) - Staff will check on resident every 1 hours and as needed to ensure [resident] has not fallen or needs assistance.? 2. The ?Resident Apartment Nighttime Safety Checks Daily Log (VA)? for resident #3 did not include documentation of staff initials verifying 2 hour rounds were completed every two hours on 03-03-2021 and 03-04-2021 from 11:00 PM through 7:00 AM; and 03-12-2021 and 03-26-2021 from 6:00 PM through 10:00 PM. 3. Resident #5?s most current ISP dated 02-24-2021 documented, ?2 hour checks (initiated on 10-06-2021) - resident will receive safety checks every two hours at night and during the day to ensure resident is safe and does not require assistance.? 4. The ?Resident Apartment Nighttime Safety Checks Daily Log (VA)? for resident #5 did not include documentation of staff initials verifying 2 hour rounds were completed every two hours on 03-01-2021 and 03-19-2021 at 11:00 PM, 1:00 AM, 3:00 AM, 5:00 AM, and 7:00 AM; 03-02-2021 and 03-25-2021 at 12:00 AM, 2:00 AM, 4:00 AM, 6:00 AM, and 7:00 AM; 03-03-2021 and 03-04-2021 from 11:00 PM through 7:00 AM; and 03-12-2021 and 03-26-2021 from 6:00 PM through 10:00 PM. 5. Staff #1 and staff #2 could not provide additional documentation indicating one hour rounds (for resident #3) and two hour rounds (for resident #5) had been conducted as indicated on the ISP?s. 6. Staff #1 and staff #2 acknowledged staff did not make rounds every hour or every two hours as required.
Plan of Correction:	*Residents #3 and #5 were discharged and no longer reside at our Branch. *One (1) hour safety checks will no longer be profiled on the service plan with the exception, if indicated, that the resident has a 1:1 safety companion in place. *All nursing BFMs will be required to review and sign/acknowledge the requirement for two (2) hour Night Time Safety Checks for those on Mary B?s and those in AL who meet the criteria for that safety measure. *The Night Time Safety Checks log will be reviewed each morning, for the previous day, to assure that they were documented completely by the BFM responsible for that task. *Weekly audits will be conducted, for the previous week, to assure that the documentation is complete, as required.
Standard #:	22VAC40-80-340-7-f
Description:	Based on record review and interview, the facility failed to adhere to the special order as provided in ? 63.2-1709.2 of the Code of Virginia and failed to contact guardians or other responsible persons of the adults currently in care in writing regarding the health and safety violations within 30 days of receipt of the special order. Evidence: 1. Special Order was mailed to the licensee on 12-15-2020 via certified mail documented: a. The licensee is required to contact guardians or other responsible persons of the adults currently in care, as authorized by ? 63.2-1709.2 (B)(6) of the Code of Virginia; b. Within 30 days of receipt of the department's Special Order, the licensee shall contact in writing the guardians or other responsible persons; c. Information provided in the contact shall include (i) the Notice of lntent, the Violation Notice upon which the Notice of lntent was based and the Special Order; (ii) the date the contact was provided; and (iii) the name of the facility contact person, their title, and contact information that the guardians or other responsible persons can contact regarding comments or questions; d. The licensee shall supply evidence to the assigned licensing inspector that contacts have been made within 15 days of completion. 2. On 01-11-2021, staff #1 was asked if the facility received the special order. Staff #1 stated the special order was mailed at the end of December. 3. On 03-30-2021, staff #1 was asked if the facility notified the guardians or other responsible persons of the special order. Staff #1 provided an email dated 03-09-2021 documenting one resident?s responsible person was notified, however; the notification only addressed 1 out of 6 areas of noncompliance documented in the Notice of Intent. 4. Staff #1 acknowledged the facility did not contact guardians or other responsible persons within 30 days of receipt of the Special Order and did not notify the assigned licensing inspector that contacts were made within 15 days of completion.
Plan of Correction:	*All components of the Special Order were completed and submitted to DSS, in its entirety, on April 15, 2021. *The required internal postings were completed on Jan. 11, 2021 and reported to DSS on Jan. 12, 2021. *All components of the Notification listed under 1. (c) were completed on March 9, 2021 to those Guardians and Responsible Parties of those residing at Bickford of Virginia Beach at that time. This was reported to DSS on March 31, 2021. *Four additional recipients, no longer at the Branch on March 9, 2021 but who were at the time that the notification should have been made in January 2021, received the identical notification on April 15, 2021. This brought the Branch into compliance with the Special Order. *Any future DSS requirements of this nature will be electronically scheduled, with a due date, and shared with the RNC, ACC and Divisional Director to assure timely completion.