VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Bickford of Virginia Beach
2629 Princess Anne Road
Virginia beach, VA 23456
(757) 821-0198

Current Inspector: Willie Barnes (757) 439-6815

Inspection Date:

Complaint Related: No

Violations:

Standard #:	22VAC40-73-70-A
Description:	Based on record review and staff interviewed, the facility failed to ensure it reported to the regional licensing office within 24 hours any major incident that has negatively affected or that threatens the life, health, safety or welfare of any resident. Evidence: 1. On 2-7-22, during complaint inspection, the inspector was provided a copy of an incident report for resident #1 for an incident that occurred on 1-27-22. Report documented admitted to hospital with pneumonia, small fractures in the lumbar and thoracic regions of the spine and sternum. Determination of how old fractures were undetermined; resident had diagnosis consistent with pathological fractures. 2. Resident?s progress note dated 1-17-22 documented resident was sent to hospital on 1-14-22 ?for possible choking/? aspiration?. 3. Resident #1?s progress notes dated 2-26-21 documented, by staff #2, noted resident had a ?stage 2 on coccyx measuring 0.5 cm X 0.2 cm?. Resident?s progress note dated 3-4-21 also documented resident was ?admitted with stage II coccyx and left heal had DTI?. This was not reported to the licensing office. 4. Facility incident reporting policy noted the following for reporting of incidents, ?PP-11150-Reportable Events (VA) -2), noted ?State-specific Reporting Requirement (a) The Branch will report to the regional licensing office within 24 hours any major incident that has negatively affected or threatens the life, health, safety or welfare of any Resident?. 5. On 2-7-22 and 2-24-22 during exit meeting, staff #1 acknowledged incident reports were not sent to licensing office.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-310-H
Description:	Based on record review and staff interview, the facility failed to ensure it did not admit or retain individuals in the assisted living with any conditions or care need prohibited by the regulation and Code of Virginia. Evidence: 1. Resident #1?s February 2022 medication administration record (MAR) documented resident prescribed Lorazepam and Haloperidol, prescriber?s order signed and dated 2-4-22. 2. On 2-7-22 a request for the treatment plans for the psychotropic medications was requested but not received. 3. On 2-7-22 during exit meeting, staff #1 and #2 acknowledged treatment plan for resident #1?s psychotropic medications was not available.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-450-C
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure the individualized service plan (ISP) included all assessed needs. Evidence: 1. Resident #1?s uniformed assessment instrument (UAI) dated 2-2-22 noted dressing need assessed as mechanical help/ physical assistance. The individualized service plan (ISP) dated 2-2-22 did not document type of mechanical help needed. Resident?s eating/feeding assessed as Supervision. The ISP documented physical/supervision, staff to setup her meal and encouragement to eat and drink at each meal. Resident prescribed a mechanical soft diet which is mechanical need. The ISP also noted resident is to be fed by staff if she is too weak to feed herself, the UAI did not assess resident as dependent with feeding/eating. 2. Resident prescribed Oxygen 2/L via nasal cannula- continuous- concentrator; prescriber signed 2-3-22 also on February 2022 medication administration record. Oxygen information also documented in resident?s Hospice Skilled Nursing Visit Noted dated 2-3-22 and electronically signed on 2-5-22. The resident?s need for Oxygen not documented on ISP dated 2-2-22. 3. On 2-7-22 during exit, staff #1 and #2 acknowledged ISP did not include all assessed needs.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-450-F
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure the individualized service plan (ISP) was updated as needed for a significant change of a resident?s condition. Evidence: 1. Resident?s record included Speech Therapy (ST) 4-26-21 for speech deficit based on hearing loss and signed by prescriber on 7-13-21. ST Re-Evaluation document for services 6-30-21 through 8-26-21, Safe Swallowing Evaluation conducted on 6-30-21; oropharyngeal dysphagia diagnosis, ST 1 X week for 4 weeks effective 7-4-21. Speech Therapy services not documented on ISP dated 3-19-21 and not on ISP dated 8-25-21. 2. Record also included a physician?s order dated 3-16-21 for ?SN HH PT/OT/ST for choking episode. 3. On 2-7-22 during exit, staff #1 and #2 acknowledgement ISP did not include all assessed needs.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-470-C
Description:	Based on record reviewed and staff interviewed, the facility failed to provide services to prevent clinically avoidable complications such as malnutrition. Evidence: 1. Resident #1?s was admitted to a local hospital on 1-27-22 and returned to the facility on 2-3-22. The hospital?s transfer summary noted on 1-28-22, ?severe protein-calorie malnutrition (Gomez: less than 60% of standard weight) HCC; frail elderly; and debility. Also noted on 1-27-22, ?pressure injury sacrum, pressure injury; spine medial?. Wound care provided and dressing changes provided during hospital stay. On 2-1-22, resident?s weigh 37.7 kg (83 lb 1.8 oz). Resident returned to facility with hospice services. 2. Hospice note dated 2-5-22, ?resident has exhibited decline by decrease appetite, decreased functional status and significant weight loss since admission to facility?.current weight is 83.61 lbs per recent hospital paperwork. In 04/2021 weight was 100 lbs >August: 90 lbs. Albumin is 1.9?. 3. On 2-24-22, during exit meeting, regulation regarding clinically avoidable complications per the regulation discussed with staff #1 and #3.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-560-E
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure the information in the resident?s record was kept current. Evidence: 1. Resident #1?s social data form documented resident preference in the event of cardiac or respiratory arrest was Do Not Resuscitate (DNR). The facility ?Resident Emergency Code Status? dated by staff #1 on 2-24-21 noted the resident as ?NO resuscitation should be attempted?.? 2. The resident?s individualized service plans (ISPs) dated 3-29-21 and 8-25-21 documented resident code status as ?DNR?. 3. On 2-4-22 the resident returned from a hospital stay with a DNR signed and dated 1-31-21. The resident?s record did not have a signed physician?s copy of a DNR order in the resident?s record until resident?s return from a local hospital on 2-3-22. 4. Staff #1 and #2 acknowledged the resident?s record did not reflect the resident?s correct code status during stay from 2-21-21 to 2-3-22.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-580-F
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure it implemented interventions as soon as a nutritional problem was suspected. Evidence: 1. Progress note dated 2-26-21 documented resident was admitted to the facility weighing 108 pounds. 2. On 2-7-22, staff #1 provided the ?Resident?s Vital Signs? form which documented resident #1?s weight from 4-1-21 through 1-27-22. This weight chart noted resident?s gradual weight loss as follows: (a) 4-1-21 (100 pounds (lbs); (b) 5-1-21 (98 lbs); (c)5-24- 21 (92 lbs); (d) 6-1-21 (90 lbs); (e) 6-10-21 (91 lbs); (f) 7-1-21 (90 lbs); (g) 8-1-21 (90 lbs); (h) 9-1-21 (90 lbs); (i) 10-1-21 (83.2 lbs); (i) 11-1-21 (86 lbs); (j) 12-1-21 (112); (k) 1-1-22 (81.4 lbs); (l) 1-25-22 (72.3 lbs) and (m) 1-27-22 (72.3 lbs). Resident #1?s weight loss from admission 2-26-21 to 1-24-22 totaled 35.7 pounds. 3. The facilities dietician report dated 7-29-21 recommended facility ?provide lots of sauces, gravies, butter, etc.? The dietician report dated 10-19-21 documented resident, ?has lost 7# in past 90 days?recommend provide resident with whole white or chocolate milk. Would resident enjoy the fortified cereal???. Review of resident?s record on 2-7-22 with facility staff did not have documentation of these recommendations. 4. Resident?s physician progress noted signed and dated 5-13-21, documented, ?Depressed mood?resident with flat affect and withdrawn possibly due to having to adjust to moving here (ALF). Continue to monitor resident weight, po intake nourishment as part of the eval for depression?. 5. Facility policy, ?PP - 40600 - Nutrition Intervention Protocol? page 1 noted, ?Residents identified as high risk may be placed on the Nutrition Intervention Protocol. High risk residents may include residents who are below Ideal Body Weight (IBW), have experienced recent weight loss, have skin breakdown, have low albumin levels, have poor food intake, etc. Special care should be taken to address those residents who have had a 5% loss in 1 month, a 7.5% gain or loss in three months or 10% gain or loss in 6 months. On 2-7-22, there was no documentation in resident?s record of nutritional intervention. 6. On 2-7-22 staff #1 and #2 acknowledged no intervention was in place for resident #1.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-680-E
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure a medical procedure or treatment ordered by a physician or other prescriber was provided according to his instructions and documented. The documentation shall be maintained in the resident record. Evidence: 1. Resident #1?s record contained a physician?s order signed and dated 5-13-21 requesting the facility, ?Check weight every two weeks X one month. Monitor food/ po intake of each meal X one week?. 2. Staff # 1 was asked about the resident?s food intake and the facility?s documentation of resident?s food consumption. Staff #1 stated the ?we do not document how much the resident eats, we don?t check to see how much they eat. We just give them their trays?. 3. Staff #1 and #2 was asked about the physician?s order in the resident?s chart requesting facility document resident?s consumption. 4. On 2-7-22 staff #1 and #2 acknowledged not being aware of such an order.
Plan of Correction:	Not available online. Contact Inspector for more information.