VIRGINIA DEPARTMENT OF SOCIAL SERVICES

SEARCH Group Home, Inc.
5742 N. Main Street
Mount jackson, VA 22842
(540) 477-2808

Current Inspector: Jeffrey Marnien (540) 571-0189

Inspection Date: Aug. 9, 2021 , Aug. 10, 2021 , Aug. 11, 2021 and Aug. 12, 2021

Complaint Related: No

Areas Reviewed:

22VAC40-73 GENERAL PROVISIONS 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 RESIDENT ACCOMODATIONS AND RELATED PROVISIONS 22VAC40-73 BUILDING AND GROUNDS 22VAC40-73 EMERGENCY PREPAREDNESS 63.2 General Provisions. 63.2 Licensure and Registration Procedures 63.2 Facilities and Programs.. 22VAC40-90 Background Checks for Assisted Living Facilities 22VAC40-90 The Sworn Statement or Affirmation 22VAC40-90 The Criminal History Record Report 22VAC40-80 THE LICENSE. 22VAC40-80 THE LICENSING PROCESS.

Technical Assistance:

Recommendations provided to the administrator: 1. Schedule contract nurses or pharmacy to provide regular in-services on medication administration. 2. Have residents sign/date that a copy of their individualized service plans (ISPs) were received (NOTE: Must be given to them after any change/update/annually).

Comments:

A renewal inspection was initiated on 8/9/2021 and concluded on 8/12/2021. The administrator was contacted by telephone to initiate the inspection. The administrator reported that the current census was five. The inspector emailed the administrator a list of items required to completed the remote documentation review portion of the inspection. The inspector reviewed two resident and two staff records, two contract staff records, selected sections of two additional staff and three additional resident records, activities calendar, menu, staff schedule, fire drills, health care oversight, medication administration records, physicians' orders, as well as other information submitted by the facility to ensure documentation was complete. The inspector conducted the on-site portion of the inspection on 8/12/2021. An exit interview was conducted with the administrator on the day 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 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 upon documentation and an interview, the facility failed to ensure a major incident was reported to the licensing office within 24 hours. EVIDENCE: 1. On 8/10/2021, the administrator submitted an incident report and medication error report to the licensing office. The medication error incident occurred on 4/11/2021. 2. On 8/12/2021, the LI interviewed the administrator and she stated, "I just thought you would review it when you did the inspection."
Plan of Correction:	Administrator has added additional notes to medication error form to copy and send to licensing within 24 hours in order to avoid a repeat offense. Health care oversight nurse will conduct quarterly in-services to ensure staff remember the importance of communication and documentation. The administrator will monitor and ensure compliance.
Standard #:	22VAC40-73-70-C
Description:	Based upon documentation and an interview, the facility failed to ensure a complete major incident report was submitted to the licensing office within seven days. EVIDENCE: 1. On 8/10/2021, the administrator submitted an incident report and medication error report to the licensing office. The medication error incident occurred on 4/11/2021. 2. On 8/12/2021, the LI interviewed the administrator and she stated, "I just thought you would review it when you did the inspection."
Plan of Correction:	Administrator has added additional notes to medication error form to copy and send to licensing within 24 hours and a full incident report within seven days. The administrator and administrative assistant will monitor and ensure compliance with this standard.
Standard #:	22VAC40-73-450-G
Description:	Based upon an interview, the facility failed to ensure five of the five residents' received a copy of their current individualized service plans (ISPs). EVIDENCE: On 8/12/2021, the licensing inspector (LI) interviewed the administrator who stated, "No, I have not given the residents a copy of their current ISPs." She indicated this was an oversight on her part as she forgot to do so.
Plan of Correction:	Administrator immediately gave each resident a copy of their current ISPs. Administrator also included a line on ISP for resident to sign when copy is received. The administrator and health care oversight staff will ensure compliance with this standard.
Standard #:	22VAC40-73-680-D
Description:	Based upon interviews and documentation, the facility failed to ensure one of five residents' medications were administered according to the physician's orders and the current medication aide curriculum. EVIDENCE: 1. On 8/10/2021, the administrator submitted an incident report and medication error report to the licensing office which stated on 4/11/2021, staff 4 administered the 8:00 am medications prepared for resident 3 to resident 4. 2. On 8/10/2021, the LI interviewed the administrator who stated, "The night shift staff was running late so the on-coming day shift staff administered the medications. Staff 4 prepared the medications for resident 3; however, he did not come for them. She left them on the cart and began to prepare the medications for resident 4 and put them in the same cup with the prepared medications for resident 3. Staff 4 then administered all of the medications prepared for 3 and 4 to resident 4 and she ingested them all. 3. Resident 3 had physician's orders signed on 12/7/2020 for the following 8:00 am medications: Lisinopril 40mg, Paroxetine 40mg, Divalproex Delayed 500mg and Buspirone HCL 30mg. 4. The medication administration record (MAR) for April 2021 for resident 3 listed Lisinopril 40mg, Paroxetine 40mg, Divalproex Delayed 500mg and Buspirone HCL 30mg as the 8:00 am medications. 5. Resident 4 had physician's orders signed on 1/25/2021 for the following 8:00 am medications: Abilify, Colace, Hair Skin and Nail caplet, Claritin, Zoloft, Thera Tablet, Vitamin D3 and Topiramate. These medications were listed on the April 2021 MAR. 6. On 8/12/2021, the LI interviewed staff 4 who stated, "The night shift staff was running late so I administered the medications. I prepared the medications for resident 3 and he did not come so I left the medication cup with the medications in it on top of the medication cart. I then prepared the medications for resident 4 and added them to the medication cup on the cart that had the medications for resident 3." When LI asked why she did not see the medications already in the cup, she stated, "I am too short to see inside the cup when it is sitting on top of the medication cart." She then stated she administered resident 3 and 4's medications to resident 4. 7. The five rights of medication administration are listed in the medication aide curriculum on page 122, Section 4.2, A.4. "Get the medication container from the cart/cabinet and read the label to verify the right client, right drug, right dose, right route, right time." 8. Page 122, Section 4.2.A.7 states, "Pour the verified medication into the appropriate container."
Plan of Correction:	Administrator posted reminders at medication cart regarding proper procedures when giving medications. An in-service will be conducted and will include proper procedures for handling any future medication errors and how to avoid them. This in-service will be for all medication aides and will be conducted by pharmacy nurse or health care oversight nurse. Administrator will ensure that in-services will be given quarterly to all medication aides reminding them of the importance of pouring only one resident's medications at a time. Medication observations will be done quarterly as well. The administrator and health care oversight nurse will ensure compliance with this standard.