VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Grayson House
110 Bedwell Street
Independence, VA 24348
(276) 773-3525

Current Inspector: Crystal Mullins (276) 608-1067

Inspection Date: Aug. 27, 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

Technical Assistance:

Please be reminded: if a resident has a legal guardian, that legal guardian must sign all paperwork such as the ISP along with the resident-if the resident wants to participate/sign.

Comments:

A renewal inspection was initiated on 08/23/2021 and concluded on 08/27/2021. The administrator was contacted by telephone to initiate the inspection. The administrator reported that the current census was 10. The inspector emailed the administrator a list of items required to complete the remote documentation review portion of the inspection. The inspector reviewed two resident records, and two staff records submitted by the facility to ensure documentation was complete. The inspector conducted the on-site portion of the inspection on 08/27/2021. An exxit 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 with applicable standards or law, and violations were documented on the violation notice issued to the faciity.

Violations:

Standard #:	22VAC40-73-640-D
Description:	Based on observations made during the medication cart audit, the facility failed to have at least one pharmacy reference book, drug guide, or medication handbook for nurses that is no more than two years old as reference materials who administer medication. EVIDENCE: 1. The facility had a pharmacy reference book dated for 2017. 2. Staff #1 stated that was the only reference book they had available.
Plan of Correction:	Facility will purchase 2 copies of pharmacy reference book. RN specialist will monitor monthly for compliance. [sic]
Standard #:	22VAC40-73-680-D
Description:	Based on observations made during resident record review and medication cart audit, the facility failed to administer medication consistent with the standards of practice outlined in the current registered medication aide curriculum approved by the Virginia Board of Nursing. EVIDENCE: 1. Resident # 1 is prescribed Acetamin 500mg tablets, take two tablets by mouth every eight hours as needed for pain and fever. 2. There is no documentation of medication administration on Resident #1's MAR for June 22, 2021-August 25, 2021 for the Acetamin 500mg tablets, take two tablets by mouth every eight hours as needed for pain and fever. 3. There were two tablets of Acetamin 500mg every eight hours as needed missing from the medication bubble packaging beside the number 15. This medication card was refilled on July 21, 2021. 4. There was no documentation of symptoms or effectiveness documented on the MAR for Resident #1 for June 22, 2021-August 25, 2021.
Plan of Correction:	Administrator and RN Specialist will complete staff training within 30 days. Documentation will be verified y meeting agenda and staff signature. RN specialist will complete monthly oversight of medication. Staff will monitor medications for prevention of errors. [sic]