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Runk & Pratt of Forest
208 Gristmill Drive
Forest, VA 24551
(434) 385-0297

Current Inspector: Jennifer Stokes (540) 589-5216

Inspection Date: March 22, 2022

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
22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS

Article 1
Subjectivity
32.1 Reported by persons other than physicians
63.2 General Provisions.
63.2 Protection of adults and reporting.
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.
22VAC40-80 COMPLAINT INVESTIGATION.
22VAC40-80 SANCTIONS.

Technical Assistance:
The licensing inspectors (LIs) had a discussion regarding standard 970-A.

Comments:
The licensing inspector (LI) for Runk & Pratt of Forest, along with another licensing inspector, conducted an unannounced renewal study on 03/22/2022 from 9:00AM until 4:00PM, finding 56 residents in care. The inspection included a tour of the physical plant, observation of a medication pass, a review of the medication storage carts, staff/resident interviews, and observation of portions of the midday meal.

Eight resident records were thoroughly reviewed, and an additional five were partially reviewed in relation to the observation of the medication pass. Sworn disclosure statements and criminal record checks were examined for all newly hired staff since the facility's last mandated inspection, and the records of four staff were thoroughly examined. Additional facility documentation was surveyed for compliance with the Standards for Assisted Living Facilities.

Findings were reviewed with facility staff during the inspection. An exit interview was conducted with the Administrator, three Administrators from other facilities owned by the licensee, the medical director's assistant, and the licensee/owner of the facility 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.

Please complete the ?plan of correction? and ?date to be corrected? for each violation cited on the violation notice and return it to your licensing inspector within 10 calendar days from today. If you have any questions, contact your licensing inspector at (540) 589-5216.

Violations:
Standard #: 22VAC40-73-1070-B
Description: Based on observation, the facility failed to ensure that when there are indications that ordinary materials or objects may be harmful to a resident with a serious cognitive impairment, these materials or objects shall be inaccessible to the resident except under staff supervision.

EVIDENCE:

During the physical plant tour of the facility at approximately 9:26 AM on the date of inspection, one licensing inspector observed an open box of plastic forks, which were accessible to all residents, on the counter in the dining area off of E-hallway.

Plan of Correction: The container of plastic forks were immediately removed from resident reach at time of inspection, all staff will be educated on the importance of objects that may be harmful will be inaccessible to residents and used under direct staff supervision.

Standard #: 22VAC40-73-50-A
Description: Based on resident record review, the facility failed to ensure that the disclosure statement to prospective residents shall be on a form developed by the department and shall include all required components.

EVIDENCE:

The records for resident 1, admitted 08/17/2021; resident 4, admitted 01/05/2022 and resident 6, admitted on 06/17/2021, contained disclosure statements (Assisted Living Facility Disclosure Statement Required By The Virginia Department of Social Services), signed on 08/17/2021; signed on 01/05/2022 and signed on 06/17/2021, (all signed by either resident and/or responsible party) that did not contain documentation on whether or not the facility has an on-site emergency electrical power source for the provision of electricity during an interruption for the normal electric power supply. The disclosure statements for residents 1, 4 and 6 were on a form developed by the facility and not on a form developed by the department.

Plan of Correction: The Resident Disclosure Statement now includes the facility on-site emergency electrical power source (generator), An addendum has been sent to all Resident Representatives, facility is waiting return receipt of this acknowledgement.

Standard #: 22VAC40-73-450-C
Description: Based on resident record review and staff interview, the facility failed to ensure that the individualized service plan (ISP) contained all required components.

EVIDENCE:

1. The ISP for resident 1, with a review date of 01/07/2022, indicated that resident 1 receives physical therapy (PT) services at the facility; however, the ISP does not indicate the agency that is providing the services and when services are to be provided.
2. The ISP for resident 4, dated 01/05/2022, indicated that resident 4 receives physical therapy (PT) services at the facility; however, the ISP does not indicate when services are to be provided.
3. The ISP for resident 8, with a review date of 01/11/2022, indicated that the resident receives physical therapy at the facility; however, the ISP does not indicate the agency that is providing the services and when services are to be provided.
4. The ISP for resident 8, with a review date of 04/17/2021, showed that the resident needs supervision during stair climbing. The uniform assessment instrument (UAI), dated 03/03/2022, showed the resident needs mechanical help and supervision human help with stair climbing. Interview with staff 6 revealed that the UAI was correct and the ISP is incorrect.

Plan of Correction: The ISP will include a written description of what services will be provided, will address identified needs, and include all require components.

Standard #: 22VAC40-73-640-A
Description: Based on document review, the facility failed to ensure that their medication management plan was implemented.

EVIDENCE:

1. The facility?s medication management plan, revised in February 2021, states the following: ?8. Methods to ensure accurate counts of all controlled substances whenever assigned medication administration staff changes. RMA/LPN will count narcotics with oncoming/off going shift and document in narcotic log record. A narcotic log is completed by off-going and on-coming RMAs/LPN and a signature is required by both RMAs/LPN per shift.?
2. The document ?Narcotic Count/Key Transfer Sheet? located in medication cart E for March 2022 and for medication cart A for February 2022 contained multiple dates that did not include a signature of the outgoing and/or oncoming registered medication aide (RMA) or nurse.

Plan of Correction: RMAs/LPNs will follow the medication management plan at all times.

Standard #: 22VAC40-73-650-A
Description: Based on resident record review, the facility failed to ensure that no medication, dietary supplement, diet, medical procedure, or treatment was changed without a valid order from a physician or other prescriber.

EVIDENCE:

1. The record for resident 5 contained a physician?s order, dated 03/02/2022, that showed the following medications to be administered daily at 7AM: aspirin 81MG, doxazosin mesylate 4MG, hydralazine 25MG, hydrocodone-acetamin 5-325MG, levetiracetam 100MG, potassium CL ER 10 MEQ, silace 50MG, tamsulosin 0.4MG, and valsartan 320 MG. The March 2022 medication administration record (MAR) for resident 5 shows that from 03/18/2022 through 03/22/2022 the aforementioned medications were administered by staff at 8AM each day.
2. The record for resident 7 contained a physician?s order, dated 11/19/2021, that showed the following medications to be administered daily at 8AM: quetiapine fumarate 12.5MG and senexon-s tablet the following medications to be administered daily and 8PM: quetinapine fumarate 25MG and senexon-s tablet. The March 2022 MAR shows that the scheduled 8AM quetiapine fumarate 12.5MG and senexon-s tablet were administered at 9AM daily from 03/01/2022 through 03/22/2022 and the scheduled 8PM quetinapine fumarate 25MG and senexon-s tablet were administered at 9PM.

Plan of Correction: No medication, dietary supplement, diet, medical procedure, or treatment will be started, changed, or discontinued by the facility without a valid order from a physician or other prescriber. Medications include prescription, over-the-counter, and sample medications. Medication dosing schedule has been updated and approved by the Physician/Nurse Practitioner to better coordinate medication administration times to ensure medications are given according to physician order.

Standard #: 22VAC40-73-680-B
Description: Based on observation during audit of the facility?s medication carts, the facility failed to ensure that medications remained in the pharmacy issued container, with the prescription label or direction label attached, until administered to residents.

EVIDENCE:

During the facility?s on-site inspection on 03/22/2022, one licensing inspector (LI) observed the following medication carts during an audit with the following pills that were not in the pharmacy issued container and laying loose in the bottom of the drawers: Cart C ? one small, white pill with an inscription of 54-840; Cart D ? one small, yellow round pill with an inscription of 4214, one white, oblong pill with an inscription of 10, one light blue, oblong pill with an inscription 1I7, and one light green, oblong pill with an inscription of 4l6 located in the second drawer; and Cart E ? one white, round pill with an inscription of G10, one light green small pill with an inscription of A, and one white, round pill with an inscription of 25 located in the second drawer.

Plan of Correction: Medications will be removed from the pharmacy container, or the container will be opened, by a RMA/LPN and administered to the resident by the same staff person. Medications shall remain in the pharmacy issued container, with the prescription label or direction label attached, until administered to the resident. Administrator/Designee will perform medication routine cart audits to ensure medication compliance. An in-service will be conducted for RMAs/LPNs.

Standard #: 22VAC40-73-680-C
Description: Based on observation during medication pass, staff interview and resident record review, the facility failed to ensure medications were administered not earlier than one hour before and not later than one hour after the facility?s standard dosing schedule, except those drugs that are ordered for specific times.

EVIDENCE:

During morning medication pass at approximately 9:23AM, staff 1 revealed to one licensing inspector (LI) that she was not able to administer resident 9?s scheduled 7AM levothyroxine 75 MCG because it was more than one hour later that the prescribed time. Staff 1 documented on the March 2022 medication administrator record (MAR) for the resident that the levothyroxine was ?not given? on 03/22/2022.

Plan of Correction: Medications shall be administered not earlier than one hour before and not later than one hour after the facility's standard dosing schedule, except those drugs that are ordered for specific times, such as before, after, or with meals.
Registered Medication Aides will be in-serviced on the importance of medications being administered according to physician orders

Standard #: 22VAC40-73-680-D
Description: Based on medication cart audit, staff interview and resident record review, the facility failed to ensure that medications were administered in consistency with the standards of practice outlined in the current medication aide curriculum approved by the Virginia Board of Nursing.

EVIDENCE:

1. During audit of medication cart E, at approximately 10:31AM one licensing inspector (LI) observed a plastic souffle medicine cup in the top drawer that contained three pills; one round dark colored pill and two round white pills labeled with 44 104. Staff 1 revealed to the LI that she had ?popped? the pills before the residents? scheduled administration time. Staff 1 stated that the two round white pills labeled with 44 104 were resident 10?s 12:00PM scheduled acetaminophen 325MG and that she could not recall which resident the one round dark colored pill was for. The record for resident 1 contained a physician?s order, dated 03/16/2022, for acetaminophen 325MG take two tablets at 12:00PM.
2. Staff 1 is a registered medication aide in the Commonwealth of Virginia. The Commonwealth of Virginia Board of Nursing Medication Aide Curriculum for Registered Medication Aides, revised on 05/21/2013, states on page 8 the following: ?3. medication aides may not pre-pour medications for anyone (self included).?

Plan of Correction: Medication?s swill be administered in accordance with the physician's or other prescriber?s instructions and consistent with the standards of practice outlines in the current medication aide curriculum approved by the Virginia Board of Nursing.

Standard #: 22VAC40-73-680-G
Description: Based on observation, the facility failed to ensure that other-the-counter medication shall remain in the original container, labeled with the resident?s name, until administered.

EVIDENCE:

During the physical plant tour of the facility at approximately 9:24 AM on the date of inspection, one licensing inspector observed an unlabeled container of Boost High Protein chocolate drinks in the refrigerator of the dining room off of E-hallway which was accessible to all residents.

Plan of Correction: Nutritional Supplements will be labeled with the resident?s name, remaining in the original label until administered. The nutritional supplements/Boost are labeled and have been moved to a secured refrigerator, not accessible to residents.

Standard #: 22VAC40-73-680-H
Description: Based on medication cart audit and resident record review, at the time a medication is administered, the facility failed to document on a medication administrator record (MAR) all medications administered to residents.

EVIDENCE:

1. The record for resident 10 contained a physician?s order, dated 01/21/2022, for lorazepam 0.5MG tablet take one tablet by mouth every 6 hours as needed (PRN) for anxiety.
2. During audit of medication cart C during on-site inspection, one licensing inspector (LI) reviewed the controlled drug record for this medication for resident 10 that showed 30 tablets were received by the facility on 10/29/2021. According to the controlled drug record, there was one remaining lorazepam 0.5MG tablet for resident 10 in the bubble pack packaging; however, the bubble pack did not contain any lorazepam 0.5MG tablets at approximately 10:24AM and this was observed by staff 1 as well.
3. The controlled drug count record for resident 10 showed that a PRN lorazepam 0.5MG tablet was administered to the resident by staff 5 on 03/11/2022 at 6:30 PM and by staff 4 on 03/15/2022 at 11:15 and 2:43; however, the March MAR for resident 10 did not show documentation that staff 4 and 5 administered the medication on these dates and times.

Plan of Correction: At the time the medication is administered, the RMA/LPN will document on a medication administration record (MAR) all medications administered to residents.

Standard #: 22VAC40-73-860-I
Description: Based on tour of the physical plant and observation, the facility failed to store cleaning supplies in a locked area.

EVIDENCE:

At approximately 9:15AM during on-site inspection on 03/22/2022, one licensing inspector (LI) noted the door to the laundry room located on D hall to be unlocked. Inside the laundry room was a spray can that contained ?Protech 5 spray disinfectant? that said ?keep out of reach of children?.

Plan of Correction: All cleaning supplies and other hazardous materials will remain in a locked area at all times.

Standard #: 22VAC40-73-870-A
Description: Based on observation, the facility failed to ensure that the interior and exterior of all buildings shall be maintained in good repair and kept clean and free of rubbish.

EVIDENCE:

1. During the physical plant tour of the facility at approximately 9:16 AM on the date of inspection, one licensing inspector (LI) observed dirty or stained carpet outside of room B1 and the adjacent exit door.
2. During the physical plant tour of the facility at approximately 9:25 AM on the date of inspection, one LI observed brown liquid stains on the cabinet faces of the island in the dining room off of E-hallway.
3. During the physical plant tour of the facility at approximately 9:28 AM on the date of inspection, one LI observed black scuff marks along the bottom part of the wall outside of room E-12 as well as in the conference room area off of the facility lobby.

Plan of Correction: The interior of the facility will be maintained in good repair and kept clean. A general cleaning of the carpet was completed on 3/24/2022. The Professional Carpet Cleaning Company is schedule to clean the carpets of the facility on April 14, 2022, then a repeat cleaning is scheduled for June 1, 2022. The cabinets and kitchen island were cleaned on the day of inspection and scuffs on walls were removed on day of inspection.

Disclaimer:
This information is provided by the Virginia Department of Social Services, which neither endorses any facility nor guarantees that the information is complete. It should not be used as the sole source in evaluating and/or selecting a facility.

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