VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Hairston Home for Adults
601 Armstead Ave
Martinsville, VA 24112
(276) 638-5121

Current Inspector: Angela Marie Swink (276) 623-6575

Inspection Date: Sept. 13, 2021

Complaint Related: No

Areas Reviewed:

22VAC40-73 ADMISSION, RETENTION, AND DISCHARGE OF RESIDENTS 22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-90 The Criminal History Record Report

Technical Assistance:

210, 260

Comments:

A renewal inspection was initiated on 9/13/2021 and concluded on 9/24/2021. The Director of Nursing (DON) was contacted by telephone to initiate the inspection. The DON reported that the current census was 28. The inspector emailed the DON a list of items required to complete the remote documentation review portion of the inspection. The inspector reviewed three resident records, three staff records, the Sworn Disclosure Statement and Criminal Record Report for all new staff members, resident roster, staff roster, staff schedule, facility healthcare oversight, fire and emergency drills, health department inspection, and dietician oversight submitted by the facility to ensure documentation was complete submitted by the facility to ensure documentation was complete. The inspector conducted the on-site portion of the inspection on 9/23/2021. An exit interview was conducted with the Administrator and Director of Nursing 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:	320-A Based on record review, the facility failed to ensure that the physical examination report contained any known allergies and a description of the person?s reactions. EVIDENCE: The physical examination form for resident 3, dated 2/5/21, indicated that the resident is allergic to ASA, Budesonide, Morphine, Sulfa drugs, and Wellbutrin; however, the form did not indicate a description of allergic reactions.
Plan of Correction:	Director of Nursing will monitor H&P reports prior to admissions to ensure all forms are completed thoroughly by hospitals. Will document effects on forms.
Standard #:	22VAC40-73-450-C
Description:	450-C Based on record review, the facility failed to ensure that the individualized service plan (ISP) shall include a description of identified needs and date identified based on other sources. EVIDENCE: 1. The record for resident 2 contained physicians orders, dated 7/27/2020, for oxygen therapy; however, the ISP for resident 2, dated 5/1/2021, did not indicate the need for oxygen therapy. 2. The admission physical examination form for resident 3, dated 2/5/21, stated that the resident has a special diet of ?easy to chew, 1800 calorie ADA, no concentrated sweets, carbohydrate consistent?; however, the ISP for resident 3, dated 2/11/21, stated that resident 3 has a regular diet.
Plan of Correction:	Individualized Service Plan will be updated by Director of Nursing (DON) to indicate source of O2 via concentrator/NC - DON will educate providers to put on Rx. Resident is on regular diet. Will document ISP for any errors. DON will monitor.
Standard #:	22VAC40-73-650-B
Description:	650-B Based on record review, the facility failed to ensure that physician or other prescriber orders, both written and oral for administration of all prescription medications shall identify the diagnosis, condition, or specific indications for administering each drug. EVIDENCE: 1. The physician?s orders for resident 1 did not contain a diagnosis for the following prescription medications: Bupropion HCL SR 150 mg tablet, Docusate Sodium 100 mg capsule, and Melatonin 5 mg tablet. 2. The physician?s orders for resident 3 did not contain a diagnosis for the following prescription medications: Eliquis 5 mg tablet, Fish Oil 1000 mg capsule, Haloperidol 5 mg tablet, Mag Oxide 400 mg tablet, and Olanzapine 10 mg tablet.
Plan of Correction:	Director of Nursing spoke with pharmacist prior to and after inspection to ensure diagnosis is to be included on all Rx script lines. They are going to send corrected labels to be put on medication.
Standard #:	22VAC40-73-700-1
Description:	700-1(A) Based on record review, the facility failed to ensure that when oxygen therapy is provided, the facility shall have a valid physician?s order that includes the oxygen source, such as compressed gas or concentrators. EVIDENCE: The physician?s order for oxygen therapy for resident 2, dated 7/27/2020, indicated oxygen use of 3 liters per minute via nasal cannula during sleep; however, the order did not identify the source(s) of the oxygen therapy ordered.
Plan of Correction:	Director of Nursing will monitor and educate PCP on need to put source of O2 on Rx - re: Concentrator, N/C.
Standard #:	22VAC40-90-40-B
Description:	22VAC40-90-40-B Based on record review, the facility failed to ensure that the criminal history record report (CRC) shall be obtained on or prior to the 30th day of employment for each employee. EVIDENCE: Documentation for staff 5 indicated a hire date of 7/21/2021; however, the CRC results have not been received.
Plan of Correction:	Director of Nursing and Administrator will call Virginia State Police to follow up on criminal history report. Will document on forms of follow up.