VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Eugene H. Bloom Retirement Center
308 Weaver Avenue
Emporia, VA 23847
(434) 348-4004

Current Inspector: Margaret T Pittman (757) 641-0984

Inspection Date: Nov. 8, 2021 , Nov. 9, 2021 , Nov. 15, 2021 and Nov. 19, 2021

Complaint Related: No

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 EMERGENCY PREPAREDNESS 22VAC40-90 Background Checks for Assisted Living Facilities 22VAC40-90 The Sworn Statement or Affirmation 22VAC40-90 The Criminal History Record Report

Comments:

A monitoring inspection was initiated on 11-9-21 and concluded on 11-19-21. The administrator was contacted by telephone to initiate the inspection. The administrator reported that the current census was 42. The inspector emailed the administrator a list of items required to complete the remote documentation review portion of the inspection. The inspector reviewed four resident records, four staff records and new hire records, activities calendar, staff schedules, fire and emergency procedures, healthcare oversight, nutrition report and pharmacy report submitted by the facility to ensure documentation was complete. The inspector conducted on-site portion of the inspection on 11-18-21. An exit interview was conducted with the administrator on 11-15-21; 11-18-21 and 11-19-21 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-compliances with applicable standards or law, and violations were documented on the violation notice issued to the facility.

Violations:

Standard #:	22VAC40-73-250-D
Description:	Based on record review and staff interview, the facility failed to ensure, each staff person shall annually submit the results of a risk assessment, documenting that the individual is free of tuberculosis (TB) in a communicative form as evidenced by the completion of the current screening form published by the Virginia Department of Health or a form consistent with it. Evidence: 1. Staff #6?s record documented the last tuberculosis date as 10-4-20. Staff?s date of hire is documented as 10-1-20. There was no current TB screening presented during the monitoring. 2. Staff #1 acknowledged, the TB screening was not updated.
Plan of Correction:	employee was unable to get an apptt for skin test until she had it done. New she has it done. Ait will keep a ledge of TB and papers will be given out a month ahead of due date.
Standard #:	22VAC40-73-310-H
Description:	Based on record reviewed, document reviewed and staff interviewed, the provider failed to ensure it did not retain anyone prescribed a psychotropic medication without a treatment plan for two of four sample residents. Evidence: 1. Resident #2?s October 2021 medication administration record (MAR) documented resident is administered Duloxetine, physician?s order dated 9-2-4-21. There was no psychotropic treatment plan submitted for this medication. 2. Resident #3?s October 2021 medication administration record (MAR) documented resident is administered Mirtazapine, physician?s order dated 9-24-21. 3. On 11-15-21 during the exit meeting staff #1 acknowledged the facility did not have a treatment plan for the aforementioned psychotropic medications prescribed for residents # 2 and #3.
Plan of Correction:	sent over to the Physician and corrected the treatment plan on resident #2 and #3 the same day 11.15.21. Each month when we check Orders and send to physician LPN will check and make sure we have A treatment plan on file for their psychotic meds.
Standard #:	22VAC40-73-450-C
Description:	Based on record review and staff interview and the facility failed to ensure the resident?s individualized service plan (ISP) included all assessed needs for two of four records . Evidence: 1. Resident #1?s uniformed assessment instrument (UAI) dated 5-11-21 documented walking with mechanical help needed. The individualized service plan (ISP) dated 5-11-21 did not include this need and assistive device of a cane. Mobility need was assessed as mechanical help/ human help/ physical assistance (mh/hh/pa); the ISP did not include this need. The resident?s record also documented resident received physical therapy and occupational therapy and completed services; this information was not documented on the resident?s ISP. 2. Resident #3?s uniformed assessment instrument (UAI) dated 7-23-21 documented bathing and dressing need as mechanical help/human help/physical assistance (mh/hh/pa); the individualized service plan (ISP) dated 7-23-21 did not document what mechanical device was needed. Resident?s UAI documented resident?s short-term memory loss, long-term memory loss and judgement problems. These cognitive areas were not addressed on the ISP. 3. Staff #1 acknowledged during the exit, all of resident #2 and #3?s assessed needs were not addressed on the ISP.
Plan of Correction:	Went over Uai's and Isp and updated and added correct information 11.20.21. Each month Nurse will check the UAI and Isp and make sure they are correct and has All pertinent information. RN who does my oversites I will get her to check them more closely. Quarterly
Standard #:	22VAC40-73-650-A
Description:	Based on record review and staff interview, the facility failed to ensure no medication, dietary supplement, diet, medical procedure, or treatment shall be started, changed, or discontinued without a valid order from a physician or other prescriber. Medications include prescription, over-the-counter, and sample medications. Evidence: 1. Resident #1?s October 2021 medication administration record (MAR) documented Amlodipine 5mg administered twice a day was started on 10-2-21 and discontinued on 10-11-21. There was no documentation of the discontinued order provided for review. 2. Staff #1 acknowledged during the exit, the discontinued order for this medication was not provided for review.
Plan of Correction:	As check MAR each month will check make sure all document is in chart
Standard #:	22VAC40-73-690-G
Description:	Based on record review and staff interview, the facility failed to ensure it followed up on recommendation by the pharmacy for a resident. Evidence: 1. Resident #3?s pharmacy review dated 8-4-21 documented weekly blood pressure while on Lisinopril and Metoprolol and daily pulse while on Metoprolol and thyroid levels every six months. There was no documentation in the resident?s record of this information being forwarded to the resident?s physician for a response. 2. Staff #1 acknowledged the recent 8-4-21 pharmacy review recommendation was not follow-up with the resident?s physician.
Plan of Correction:	followed up on Pharmacy review request with Physician and not its on the Mar. Ait will follow up and mark off as we get them back so this oversite doesn't happen anymore. Will follow up with Physician until they sign they agree or don't agree and have it documentated.