VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Chesapeake Place
1500 & 1508 Volvo Parkway
Chesapeake, VA 23320
(757) 548-0808

Current Inspector: Donesia Peoples (757) 353-0430

Inspection Date: June 14, 2021 , June 16, 2021 , June 21, 2021 , June 30, 2021 and July 1, 2021

Complaint Related: Yes

Comments:

A non-mandated complaint inspection was initiated on 06-14-2021 and concluded on 07-01-2021. A complaint was received by the department regarding allegations in the areas of staffing, resident care, medication, and medication administration. The Administrator was contacted by telephone to conduct the investigation. The licensing inspectors emailed the Administrator a list of documentation required to complete the investigation. The licensing inspector conducted an on-site observation at the facility on 07-01-2021. The evidence gathered during the investigation supported the allegations of non-compliance with standards or law, and violations were issued. Any violations not related to the complaint but identified during the course of the investigation can be found on the violation notice.

Violations:

Standard #:	22VAC40-73-290-A
Complaint related:	No
Description:	Based on record review and discussion, the facility failed to maintain a copy of the schedule for two years. Evidence: 1. Staff #1 was asked to provide a copy of the staff schedule for April 2021; however, the schedules for 04-01-2021 through 04-17-2021 could not be provided. 2. Staff #1 and staff #2 acknowledged the facility did not have a copy of the aforementioned staff schedules.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-680-C
Complaint related:	Yes
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. Staff #1 provided a copy of the facility?s standard dosing schedule labeled ?Routine Hours of Medication Administration? which documented, ?The following times will be the routine hours of administration for the facility unless facility staff request an alternate schedule. Daily 8:00 AM; QAM 8:00 AM; QPM 4:00 PM; BID 8:00 AM, 4:00 PM, or 8:00 AM, 8:00 PM; TID 8:00 AM, Noon, 4:00 PM, or 8:00 AM, Noon, 8:00 PM? Routine medications may be administered one hour (before or after) the times indicated on the Medication Administration Record?? 2. May 2021 and June 2021 Medication Administration Records (MAR?s) documented the following scheduled administration times: A. Resident #1?s scheduled 9:00 AM medications to include Risperidone 0.5mg, Metformin 850mg, and Flovent 220mcg was administered at 11:28 AM on 05-25-2021, at 7:20 AM on 05-30-2021, and at 10:28 AM on 06-06-2021; Miconazole 2%, Lisinopril 5mg, Metoprolol Suc 25mg crea, and Buspirone 5mg scheduled at 8:00 AM was administered at 11:28 AM on 05-25-2021, at 10:10 AM on 05-26-2021, and at 10:21 AM on 06-03-2021, and scheduled 4:00 PM doses were administered at 5:58 PM on 05-27-2021; Metoprolol Suc 25mg scheduled at 8:00 AM was administered at 10:28 AM on 06-06-2021; Latanoprost 0.005% scheduled at 8:00 PM was administered at 11:17 PM on 05-19-2021 and at 9:29 PM on 05-24-2021. B. Resident #2?s scheduled 9:00 AM medications to include Furosemide 20mg, Escitalopram 20mg, Co Q-10 100mg, Certavite Tab, Aspirin 81mg, Vitamin D3, Vitamin B-1 100mg, Losartan 100mg, Isosorb Mono 60mg, Systane Complete 0.6%, and Diclofenac gel 1%, was administered at 7:27 AM on 05-24-2021, at 10:25 AM on 05-27-2021, at 10:49 AM on 06-03-2021, and 1:11 PM on 06-05-2021; Diclofenac Gel 1% scheduled at 1:00 PM was administered at 2:55 PM on 05-26-2021, and at 2:58 PM on 06-01-2021; Bystolic 5mg scheduled at 8:00 PM was administered at 12:20 AM on 06-01-2021, and at 9:40 on 06-14-2021; and Trazadone 50mg scheduled at 9:00 PM was administered at 11:24 PM on 05-19-2021, at 11:45 PM on 05-25-2021, at 11:37 PM on 05-28-2021, at 12:20 AM on 06-01-2021, and at 7:34 PM on 06-06-2021. C. Resident #3?s scheduled 9:00 AM medications to include Midodrine 5mg, Certavite, Cholestryam 4mg, Mag Oxide 400mg, Pot Cl 20 MEQ, and Xarelto 20mg was administered at 10:37 AM on 05-21-2021, at 1:10 PM on 05-22-2021, at 11:49 AM on 05-25-2021, at 11:38 AM on 05-26-2021, at 12:54 PM on 05-27-2021, and at 7:12 AM on 05-30-2021. 3. Staff #1 and staff #2 did not provide documentation of an alternate medication schedule and acknowledged the residents? aforementioned medications were not administered within the correct times.
Plan of Correction:	RCD & RCC will set up alerts to inform of late and missed meds, this will force MT to have to explain late or missed medication. MT to notify RCD, physician and POA immediately if medication is missed. In-services will be conducted with MTs to re-educate medication administration procedures. RCD & RCC will verify last orders received daily to ensure accuracy and that alert charting is correct and activated in system. They will indicate start and stop dates and times when required.
Standard #:	22VAC40-73-680-D
Complaint related:	No
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 physician?s order dated 05-07-2021 documented, ?Clindamycin HCL- 150mg Oral Capsule (20 Capsules) [for 5 days] - Take 1 Capsule every 6 hours daily.? 2. Resident #1?s May 2021 Medication Administration Record (MAR) documented: A. The first dose of Clindamycin 150mg was administered at 12:00 PM on 05-10-2021 and the last dose was administered at 6:00 PM on 05-12-2021. B. The resident only received Clindamycin 150mg for 2.5 days. C. The scheduled dosing times for Clindamycin 150mg were scheduled at 12:00 AM, 8:00 AM, 12:00 PM, and 6:00 PM, which was not every 6 hours as directed by the physician. 3. Staff #2 and staff #3 did not provide a discontinued order for the Clindamycin 150mg, and acknowledged resident #1 did not receive the Clindamycin 150mg as directed by the physician. 4. Resident #1?s signed physician?s order dated 05-01-2021 documented, ?Glucophage 850mg [Metformin] once a day. Increase to 850mg PO [by mouth] BID [twice a day] in 2 weeks [14 days].? 5. Resident #1?s May 2021 MAR documented: A. The first dose of Metformin 850mg was administered on 05-04-2021. B. The resident received Metformin 850mg once a day from 05-04-2021 to 05-15-2021 [12 days]. C. The resident started receiving Metformin 850mg twice a day on 05-16-2021; instead of starting on 05-18-2021. 6. Staff #1, staff #2, and staff #3 acknowledged resident #1 did not receive the Metformin as ordered by the physician. 7. Resident #3?s signed physician?s order dated 04-27-2021 documented, ?Gabapentin Cap 100mg- Take 2 capsules = 200mg by mouth every 8 hours for Pain/Myeloma.? The order also documented ?Midodrine Tab 5mg- Take 1 tablet by mouth every eight hours for Hypotension.? 8. Resident #3?s May 2021 MAR documented: A. Staff administered Gabapentin 300mg- 1 capsule by mouth three times a day on 05-01-2021 through 05-31-2021. Staff administered Gabapentin 300mg at 9:00 AM, 1:00 PM, and 5:00 PM, which was not every 8 hours. B. Staff administered Midodrine 5mg at 9:00 AM, 1:00 PM, and 5:00 PM, which was not every 8 hours. 9. Staff #1, staff #2, and staff #3 acknowledged resident #3?s Gabapentin and Midodrine were not administered every 8 hours as ordered by the physician.
Plan of Correction:	RCD & RCC will set up alerts to inform of late and missed meds, this will force MT to have to explain late or missed medication. MT to notify RCD, physician and POA immediaet ly if medication is missed. In-services will be conductedwith MTs to re-educate medication administration procedures. RCD & RCC will verify last orders received daily to ensure accuracy and that alert charting is correct and activated in system.They will indicate start and stop dates and times when required.
Standard #:	22VAC40-73-680-I
Complaint related:	No
Description:	Based on record review and interview, the facility failed to ensure the Medication Administration Record (MAR) included the initials of direct care staff administering the medications. Evidence: 1. May 2021 MAR?s did not include the initials of direct care staff administering the following scheduled medications: A. Resident #2?s 8:00 AM Hydralazine on 05-03-2021; 9:00 AM Ensure, Escitalopram 20mg, Furosemide 20mg, Isosorb 60mg, Losartan 100mg, Omeprazole 20mg, Pot Cl. 20 MEQ, Systane Complete, Vit D3, Vitamin B-1 100mg, and Diclofenac gel 1% on 05-03-2021; 9:00 AM Furosemide 20mg on 05-14-2021, 05-25-2021, and 05-26-2021; 10:00 PM Gabapentin 100mg on 05-11-2021 and 05-21-2021 and at 2:00 PM on 05-06-2021 through 05-08-2021, 05-12-2021 through 05-14-2021, 05-16-2021, 05-22-2021 through 05-24-2021, 05-27-2021, and 05-31-2021; 12:00 PM Hydralazine 50mg on 05-08-2021, 05-14-2021, 05-22-2021 and 05-23-2021; and Trazadone 50mg on 05-11-2021 and 05-21-2021. B. Resident #3?s 1:00 PM Gabapentin 300mg on 05-06-2021; 9:00 AM Midodrine 5mg on 05-17-2021 and at 1:00 PM on 05-06-2021, 05-22-2021, 05-23-2021, and 05-25-2021; 2:00 PM Oxycodone 5mg on 05-06-2021, 05-12-2021, 05-13-2021, 05-17-2021, 05-19-2021, and 05-23-2021; and 9:00 AM Xarelto 20mg on 05-20-2021, 05-22-2021, and 05-23-2021. 2. Staff #1 and staff #2 acknowledged the aforementioned dates did not include the initials of the direct care staff administering the medications.
Plan of Correction:	RCD and ED to re-educate staff on using paper MARs in the event computer systems not available.