VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Commonwealth Senior Living at Hillsville
100 Kyle Drive
Hillsville, VA 24343
(276) 728-5333

Current Inspector: Crystal Mullins (276) 608-1067

Inspection Date: Sept. 23, 2021

Complaint Related: Yes

Areas Reviewed:

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 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS Article 1 Subjectivity

Comments:

A non-mandated complaint inspection was initiated on 08/20/2021 and concluded on 09/24/2021. A complaint was received by the department regarding allegations in the areas of personnel, staffing, resident care and related services, resident accommodations and related provision, building and grounds, and adults with serious cognitive impairments. The administrator was contacted by telephone to conduct the investigation. The licensing inspector conducted an on-site observation at the facility on 09/23/2021. 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 #:	22VAC40-73-650-A
Complaint related:	No
Description:	Based on observations made during the review of resident records and the tour of the building, the facility failed to have a valid physician's order for two medications in one resident's room. EVIDENCE: 1. Resident #1 was observed to have a bottle of hydrogen peroxide and a package of honey lemon menthol cough drops sitting on his bathroom vanity. 2. Resident #1 did not have a physician's order for hydrogen peroxide or honey lemon menthol cough drops. 3. Resident #1 has a UAI dated 04/19/2021 that rates him dependent in medication administration.
Plan of Correction:	Resident Care Director received order from PCP for resident to have medication in room and self-administer. Resident Care Director and/or designee will do random room ?sweeps? to ensure compliance with medication management policies. [sic]
Standard #:	22VAC40-73-860-J
Complaint related:	No
Description:	Based on observations made during the tour of the building, the facility failed to ensure that each resident that is permitted to keep his own cleaning supplies or other hazardous materials in his room be stored so they are in an out-of-sight place. EVIDENCE: 1. Resident #1 was observed to have a can of Lysol disinfectant spray sitting in his bathroom. This was not stored in an out-of-sight place.
Plan of Correction:	Housekeeping removed the can of Lysol from the resident room. Housekeeping was in-serviced on hazardous materials and what is and is not allowed in resident rooms. Housekeeping and/or designee will complete random room audits to ensure compliance. [sic]
Standard #:	22VAC40-73-870-A
Complaint related:	No
Description:	Based on observations made during the tour of the building, the facility failed to maintain the interior and exterior of all buildings in good repair and keep it clean and free of rubbish. EVIDENCE: 1. The trash dumpster outside of the building was found to be open and found to have approximately ten used blue gloves and other trash scattered about.
Plan of Correction:	Maintenance Director cleaned up around dumpster area. Maintenance Director and/or designee will do an external walk of the dumpster area periodically to ensure it is clean and free of rubbish. [sic]
Standard #:	22VAC40-73-870-E
Complaint related:	No
Description:	Based on observations made during the tour of the building, the facility failed to ensure that all furnishings, fixtures, and equipment shall be kept clean and in good repair and condition. EVIDENCE: 1. Resident #2 has a ceiling vent fan that does not have a cover in the bathroom. 2. Resident #3 has a leak in the ceiling. There is a white trash can sitting on the floor under the leak that had approximately three inches of water in the trash can.
Plan of Correction:	Maintenance Director repaired leak in ceiling and ceiling vent fan. Maintenance Director &/or designee will ensure ceiling is free from leaks by doing random walks through community to inspect. Also during these walks, vent fans will be checked randomly. [sic]
Standard #:	22VAC40-73-920-C
Complaint related:	No
Description:	Based on observations made during the tour of the building, the facility failed to ensure there is ventilation in the bathrooms to the outside in order to eliminate foul odors. EVIDENCE: 1. Resident #4 has a ceiling vent fan in the bathroom that is inoperable.
Plan of Correction:	Maintenance Director repaired ceiling van in bathroom. Maintenance Director and/or designee will do fan checks randomly throughout the community to ensure they are in working order. [sic]
Standard #:	22VAC40-73-930-D
Complaint related:	No
Description:	Based on documentation review, the facility failed to ensure the two hour documented rounds in memory care were utilized in the proper manner. EVIDENCE: 1. The 08/25/2021 round sheet for 7pm and 9pm have two staff initials documented as completing the two hour rounds. LI received a picture of this documentation at 7:04pm on 08/25/2021. This indicates the 9pm rounds were documented as complete prior to 9pm(pre-signed). 2. The 09/12/2021 round sheet for 3am and 4am and 5am and 6am have staff initials documented as completing the two hour rounds. LI received a picture of this documentation at 2:57 am on 09/12/2021 for the 3am and 4am documentation and received a picture of this documentation at 2:58 am on 09/12/2021 for the 5am and 6am documentation. This indicates the 3am, 4am, 5am, and 6 am rounds were documented as complete prior to 2:57am (pre-signed).
Plan of Correction:	Staff has been in-serviced on ensuring they are not pre-signing round sheets. Resident Care Director or designee will audit round sheets throughout random shifts to ensure compliance. [sic]