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: May 3, 2021 , May 4, 2021 , May 5, 2021 and May 6, 2021

Complaint Related: No

Areas Reviewed:

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 EMERGENCY PREPAREDNESS 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS Article 1 Subjectivity

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 05-03-2021 and concluded on 05-06-2021. The Administrator was contacted by telephone to initiate the inspection. The Administrator reported that the current census was 60. The inspector emailed the Administrator a list of items required to complete the inspection. The inspector reviewed 4 resident records, 4 staff records, criminal background checks and sworn disclosures of newly hired staff, staff schedules, fire drills, fire and health inspection reports, dietary oversight, and healthcare oversight. 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 #:	22VAC40-73-450-F
Description:	Based on record review and interview, the facility failed to ensure the Individualized Service Plan (ISP) was reviewed and updated as needed as the condition of the resident changes. Evidence: 1. Resident #4?s signed physician?s orders dated 02-23-2021 documented, oxygen- 2L via NC [nasal cannula] PRN [as needed]. The current ISP dated 06-15-2020 was not updated to reflect the new need for oxygen. 3. Resident #2?s ?Report of Resident Physical Examination? dated 07-24-2020 documented a no added salt diet. The resident?s signed physician?s order dated 03-22-2021 documented ?Mechanical soft diet w/chopped meats. Thickened liquids (Nectar thick)?; however, the current ISP dated 02-11-2021 was not updated to reflect the resident?s current diet. 4. Resident #3?s ?Home Health Certification Plan of Care? form documented a start of care for skilled nursing on 03-18-2021 for an open wound. Home Health notes dated 05-04-2021 documented the resident continues to receive nursing services for wound care. The current ISP dated 01-26-2021 was not updated to reflect the need for skilled nursing services for wound care. 5. Staff #1 and staff #2 acknowledged the residents ISP?s were not updated to reflect the residents aforementioned needs.
Plan of Correction:	*Resident #4, #2, and #3 had their ISP?s updated to reflect the most current orders provided by their Providers. *All new orders are to be faxed to ValuMed Pharmacy as soon as feasibly possible after receipt to assure that the order was profiled correctly, activated in QuickMar, and appropriate items delivered, if indicated. * A copy of all new orders will be placed in a designated ?New Orders? binder to be referenced by the RNC and ACC while updating the ISP. The RNC and ACC will profile and then initial those items appropriate for inclusion on the ISP. *The RNC and ACC, together, will cross audit the ISP against the Physician Order Sheet and UAI, when routine updates occur, to assure that all required items are profiled on the ISP. *The ISP will be reviewed, and signed, by the RNC or ACC, the Director, the designated Resident Representative, and the Resident (when appropriate).
Standard #:	22VAC40-73-650-B
Description:	Based on record review and interview, the facility failed to ensure prescriber?s orders for administration of all prescription and over-the-counter medications, identified the diagnosis or specific indications for administering each drug. Evidence: 1. Resident #1?s signed prescriber?s orders did not include a diagnosis or specific indications for Sodium Bicar 650mg (order dated 04-01-2021); Seroquel 25mg and Lexapro 10mg (order dated 04-15-2021); and Norvasc 5g (order dated 04-15-2021). 2. Staff #1 and staff #2 acknowledged resident #1 prescriber?s orders did not include the diagnosis or specific indications for administering the aforementioned medications.
Plan of Correction:	*The resident?s Provider was called to confirm the appropriate diagnosis and indications for use for those medications referenced. *Resident #1 MAR was updated to include an appropriate diagnosis for all medications ordered. *All resident MARs will be audited to assure that all medications ordered have a corresponding diagnosis and indication for use, if indicated. * 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.
Standard #:	22VAC40-73-680-D
Description:	Based on record review and interview, the facility did not administer medications in accordance with the physician's instructions. Evidence: 1. Resident #2?s signed oral physician?s order dated 04-02-2021 documented, ?Decrease afternoon dose of Seroquel to 25mg for agitation?? 2. Resident #2?s April 2021 Medication Administration Record documented staff administered 1 tab of Seroquel 50mg at 1:00 PM on 04-03-2021 through 04-05-2021. 3. Prescriber #1 (NP) acknowledged resident #2 was not administered the correct dose of Seroquel for 3 days.
Plan of Correction:	*The Provider was notified that resident #2 dose reduction, ordered on April 2, 2021, did not start until April 6, 2021. *All new orders are to be faxed to ValuMed Pharmacy as soon as feasibly possible after receipt. Any delays in that process are to be reported to the Provider as soon as the delay is discovered for notification purposes and to inquire if any additional orders are required. *A copy of all new orders will be placed in a designated ?New Orders? binder, that will be checked daily for 1st and 2nd checks, to assure that the order was profiled correctly, activated in QuickMar, and delivered if indicated. *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 #:	22VAC40-73-970-E
Description:	Based on record review and interview, the fire and emergency evacuation drills record did not identify the person conducting the drill nor method used for notification of the drill. Evidence: 1. Fire and emergency evacuation drill conducted on 04-28-2021 did not include the person?s name conducting the drill. 2. Fire and emergency evacuation drill conducted on 02-28-2021 did not include the method used for notification of the drill. 3. Staff #1 did not provide additional documentation of the aforementioned requirements and acknowledged the aforementioned information was not recorded on the fire and emergency evacuation drills.
Plan of Correction:	*The forms used to document the Fire Drills conducted on 2/28/2021 and 4/28/2021 had the missing information added to those forms, and those forms were provided to the Licensing Inspector on 5/6/2021 *Moving forward, all Fire Drill forms will be reviewed and countersigned by one of Bickfords? Directing Family Members to assure that all required areas on the form are completed, as required, and that the form contains no blank areas.