VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Gray Ridge Village LLC
155 Ridgefield Rd
Marion, VA 24354
(276) 521-0784

Current Inspector: Rebecca Berry (276) 608-3514

Inspection Date: July 9, 2021

Complaint Related: No

Comments:

A renewal inspection was initiated on 07/09/2021 and concluded on 07/15/2021. The administrator was contacted by telephone to initiate the inspection. The administrator reported that the current census was 58. The inspector emailed the administrator a list of items required to complete the remote documentation review portion of the inspection. The inspector reviewed 4 resident records, 4 staff records, the staff schedule for the past two week, most recent health and fire inspection reports, most recent health and dietitian oversights,, fire and emergency drills for the past year, and the activity calendar and menu for the current month submitted by the facility to ensure documentation was complete. The inspector conducted the on-site portion of the inspection on 07/14/2021. An exit interview was conducted with the Administrator on the date of inspection, where findings were reviewed and an opportunity was given for questions, as well as for providing any information or documentation which was not available during the inspection. 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 #:	22VAC40-73-320-A
Description:	Based on documentation review, the facility failed to ensure that the physical examination form for one resident in the sample contained all of the required information. EVIDENCE: 1. The physical examination for resident # 4 dated 03/10/2021 did not include the resident?s address, telephone number, the general physical condition of the resident or the description of reactions to the allergies listed.
Plan of Correction:	All physical exam forms will be complete prior to admission to facility. Admin. will monitor. [sic]
Standard #:	22VAC40-73-660-B
Description:	Based on observations made during the morning tour of the building, review of medications administration records and physician?s orders, the facility failed to ensure that medications are only kept in resident rooms when a resident is assessed as being able to self-administer their own medications. EVIDENCE: 1. The Licensing inspector observed an Albuterol Sul HFA 90 Mch inhaler on the bedside table of resident # 1. 2. The Uniform Assessment Instrument (UAI) dated 01/28/2021 for resident # 1 has documentation this resident requires the assistance of a lay person to administer medications. According to the record for this resident, she did have a physician?s order for this medication dated 04/27/2021 to inhale 2 puffs into lungs every four hours as needed for shortness of breath. The order does not say she can self-administer this medication. There was no documentation on the medication administration record resident # 1 was receiving this medication.
Plan of Correction:	Staff re-educated on medication admin and storage. Staff re-educated on orders for self admin. meds and orders to keep meds at bedside. All meds will be stored per regulations. Admin. will monitor [sic]
Standard #:	22VAC40-73-680-D
Description:	Based on review of Medication Administration records, physicians orders and the medication cart, the facility failed to administered all resident medications in accordance with physician?s or other prescriber?s instructions for one resident in care. EVIDENCE: 1. According to physician?s orders dated 06/14/2021 Resident # 4 is prescribed Nystop 100,00 units/gm powder apply to the affected area(s) on the trunk three times daily and may self-administer this medication. 2. This medication was not located on the medication cart or in resident # 4?s room. 3. According to the medication administration record resident # 4 refused this medication a total of 33 times and it was documented resident # 4 had last received this medication on July 12. The inspection was conducted on July 14.
Plan of Correction:	All meds will be on med cart and available as ordered by MD. Med orders will be checked by 2 different staff in med room. Admin. will monitor [sic]