VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Riverside Assisted Living at Patriots Colony
6200 Patriots Colony Drive
Williamsburg, VA 23188
(757) 220-9000

Current Inspector: Willie Barnes (757) 439-6815

Inspection Date: April 5, 2022 and April 6, 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 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.

Comments:

An unannounced renewal inspection was conducted on 4-5-22 and 4-6-22 by two inspectors from the Peninsula Licensing Office. The facility census on 4-5-22 was 63. A tour of the assisted living and safe, secure unit was conducted with staff from the nursing center. A medication pass observation was conducted on both units, resident and staff interviews were conducted, emergency preparedness material were reviewed, breakfast was observed on the ALF unit and the first aid kits were checked for compliance. A review of issues, concerns, violations were reviewed with staff throughout the inspection process. An exit was conducted with the Administrator and Manager. The acknowledgement form was sent via email and signed by the administrator following the exit. Please complete the columns for "description of action to be taken" and "date to be corrected" for each violation cited on the violation notice, and then return a signed and dated copy to the licensing office within 10 calendar days of receipt. You need to be specific with how the deficiencies either have been or will be corrected to bring you into compliance with the Standards. Your plan of correction must contain the following three points: 1. Steps to correct the noncompliance with the standard(s) 2. Measures to prevent the noncompliance from occurring again 3. Person(s) responsible for implementing each step and/or monitoring any preventive measure(s) Please provide your responses in a Word Document, if possible. POC due within 10 days (4-24-22).

Violations:

Standard #:	22VAC40-73-1180-B
Description:	Based on observation and staff interview, the facility failed to ensure when there are indications that ordinary materials or objects may be harmful to a resident, these materials or objects shall be inaccessible to the resident except under staff supervision. Evidence: 1. On 4-5-22 during a tour of the safe, secure unit with staff #10 and #11 the following items were observed in resident #5?s bathroom: hand- sanitizer, two tubes of protective ointment, shampoo and a bar of soap. 2. Staff #10 and #11 acknowledged the items were in the resident?s bathroom.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-310-H
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure it did not admit or retain individuals with any prohibitive conditions or care needs for four of seven residents. Evidence: 1. Resident #3?s April 2022 medication administration record (MAR) documented resident prescribed Lorazepam. The treatment plan dated 1-27-22 did not include this include this psychotropic medication. 2. Resident #4?s April 2022 MAR documented resident prescribed Haldol and Xanax. The treatment plan dated 2-18-22 did not include these psychotropic medications. 3. Resident #5?s February 2022 MAR documented resident prescribed Seroquel and Lorazepam. The treatment plan dated 4-5-22 did not include these psychotropic medications. 4. Resident #7?s February 2022 MAR documented resident prescribed Lorazepam. The treatment plan dated 1-27-22 did not include this psychotropic medication. 5. On 4-5-22 and 4-6-22 during the exit meeting, staff #1 and #2 acknowledged the aforementioned residents? psychotropic treatment plans did not include all psychotropic medications.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-380-A
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure prior to or at the time of admission to the assisted living facility, the required personal and social information for five of seven residents were obtained and kept current in the residents? records. Evidence: 1. Resident #4?s personal and social information document noted the resident as ?Full Code?. The resident?s record included a ?POST? document which noted resident preference as ?Do Not Resuscitate?. The ?POST? document was signed and date by the physician on 5-29-20. The social and personal document was not updated to reflect resident?s current status in the event of cardiac or respiratory arrest. 2. Resident #1?s record did not include a personal and social information document. The resident?s date of admission was documented as 7-16-21. 3. Resident #3?s record did not include a personal and social information document. The resident?s date of admission was documented as 12-10-20. 4. Resident #5?s record did not include a personal and social information document. The resident?s date of admission was documented as 2-15-22. 5. Resident #6?s record did not include a personal and social information document. The resident?s date of admission was documented as 1-31-22. 6. On 4-5-22 and 4-6-22 during the exit meeting, staff #1 and #2 acknowledged the aforementioned residents? record did not include the personal and social data information and resident #4?s social data form was not updated to reflect DNR status.
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 for two of seven residents. Evidence: 1. Resident #4?s record documented hospice services, dated 3-9-22 was being provided. The individualized service plan (ISP) dated 3-14-22 did not include what hospice services were provided. The ISP also documented psychological services but did not include who and when psychological services were being provided. 2. Resident #6?s uniformed assessment instrument (UAI) dated 9-24-21 documented dressing need assessed as physical assistance. The ISP dated 9-26-21 did not document the type of assistance needed. 3. On 4-5-22 and 4-6-22, staff #1 and #2 acknowledged the aforementioned residents? ISP did not include all assessed needs.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-640-A
Description:	Based on observation and staff interviewed, the facility failed to monitor the medication cart to ensure it prevented the use of outdated, damaged, or contaminated medications. Evidence: 1. On 4-5-22 during the medication pass observation with staff #3, resident #3?s Epipen?s label noted the pen was to be discarded 3-31-22. The Epipen remained on the cart until the inspector inquired about expired items on the medication cart. 2. Staff # 3 acknowledged the Epipen had expired and was on the medication cart on 4-5-22 during the medication observation.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-710-B
Description:	Based on record observation, record reviewed and staff interviewed, the facility failed to ensure a medical restraint would only be used according to a physician?s written order and the written consent of the resident or the legal representative. Evidence: 1. On 4-5-22 during a tour of the safe, secure unit (SCU), a type of bedrail was observed on resident #1?s bed. The resident could not demonstrate the use of the rail, but stated it was for ?safety?. The resident continue to repeat the word ?safety? and became agitated by the questions and want to go and complete a crossword book. 2. The resident?s individualized service plan (ISP) dated side-rails were in place for positioning. The record did not include a physician?s written order nor the written consent of the legal representative for the side-rails. The ISP noted for the side-rails the staff would provide services. 3. On 4-5-22 and 4-6-22 during the exit meeting, staff #1 and #2 acknowledged the facility did not have the required documents from the legal representative physician for the side-rail.
Plan of Correction:	Not available online. Contact Inspector for more information.