VIRGINIA DEPARTMENT OF SOCIAL SERVICES

SEARCH Group Home, Inc.
5742 N. Main Street
Mount jackson, VA 22842
(540) 477-2808

Current Inspector: Jeffrey Marnien (540) 571-0189

Inspection Date: May 26, 2022

Complaint Related: No

Areas Reviewed:

22VAC40-73 RESIDENT CARE AND RELATED SERVICES

Technical Assistance:

1. Discussed the need to review the medication administration records (MARs) every month immediately upon receipt from the pharmacy and prior to using the new MAR to ensure all information is accurate and complete - even when there have been no changes or new orders. 2. Conducting interviews with residents and staff on medication administration practices and conducting more frequent medication administration observation audits, especially on night shift, to ensure compliance with the standards.

Comments:

Type of inspection: Monitoring Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 5/26/2022 from approximately 10:30 am to 12:30 pm The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. A self-reported incident was received by VDSS Division of Licensing on 4/24/2022 regarding allegations in the area of resident care and related services. Number of residents present at the facility at the beginning of the inspection: 5 Number of resident records reviewed: 2 Number of staff records reviewed: 1 Number of interviews conducted with residents: 1 Number of interviews conducted with staff: 3 An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation supported the self-report of non-compliance with standards, and violations were issued. Any violation(s) not related to the self-report but identified during the course of the investigation can also be found on the violation notice. The licensee has the opportunity to submit a plan of correction to indicate how the cited violations will be addressed in order to return the facility to compliance and maintain future compliance with applicable standards or law. If the licensee wishes to provide a plan of correction: (i) type the plan on a separate Word document, (ii) identify the standard violation number being addressed, (iii) include the date the violation will be corrected, (IV) do not include any names or confidential information, and (V) return to the licensing inspector by email within five (5) business days of the exit interview. Compliance with all applicable regulations and law shall be maintained and any areas of noncompliance must be corrected. Within 15 calendar days of your receipt of the inspection findings (inspection summary, violation notice, and supplemental information), you may request a review and discussion of these findings with the inspector's immediate supervisor. To make a request for review and discussion, you must contact the licensing supervisor at the regional licensing office that serves your geographical area. Regardless of whether a supervisory review has been requested, the results of the inspection will be posted to the DSS public website within 5 business days of your receipt of the Inspection Summary and/ or Violation Notice. The department's inspection findings are subject to public disclosure. Please Note: A copy of the findings of the most recent inspection are required to be posted on the premises of the facility. For more information about the VDSS Licensing Programs, please visit: www.dss.virginia.gov Should you have any questions, please contact Janice Knight, Licensing Inspector at (540) 430-9258 or by email at janice.knight@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-680-D
Description:	Based upon documentation and interviews, the facility failed to ensure medications for one of two residents were administered in accordance with the physicians' orders and consistent with the standards of practice outlined in the current medication aide curriculum approved by the Virginia Board of Nursing. Evidence: 1. Resident 1 had physician's orders signed 1/31/2022 for one 30mg tablet Aripiprazole and one 100mg tablet Sertraline at 8:00 pm, and one 25mg tablet of Topiramate and one 2mg tablet of Quanfacine at 9:00 pm. 2. Rsident 2 had physician's orders signed 3/22/2022 for one 20mg tablet Atorvastatin, one 180 mg tablet Vitamin E, three 300mg capsules Lithium Carbonate, one half 0.5mg tablet (0.25mg) Clonazepam at 8:00 pm. 3. The medication administration record (MAR) for resident 2 indicated that on 4/23/2022, staff 1 administered one 30mg tablet Aripiprazole, one 100mg tablet Sertraline, one 25mg tablet Topiramate and one 2mg tablet Quanfacine to resident 2 in error. 4. On 4/26/2022, licensing inspector (LI) conducted a telephone interview with staff 1 who stated, "I went to the medication room and prepared the 8:00 pm pills for residents 1 and 2 by placing the single bubble packs with the label of each medication still attached, into the medication cup for each resident. When I went to administer the medications to resident 2, I picked up the wrong cup and resident 2 was talking and took the cup out of my hand and took the medications which were for resident 1. As soon as he took them I realized what happened." 5. On 5/26/2022, the LI interviewed resident 2 who stated, "Staff 1 gave me the wrong medications." 6. The medication aide curriculum states, on page 44, Section 2.6, "The rules for medication administration are universal. We call these rules the "Five Rights" of Medication Administration. These rules apply to every medicine, every client and every HCP at all times. A. The Five Rights 1. Right Client 2. Right Drug 3. Right Dose 4. Right Route 5. Right Time"
Plan of Correction:	Staff 1 was reminded not to give medication except at the med cart with only one resident present each time a med is given, so as not to be distracted. Administrator spoke with Staff 1 regarding Five Rights and the importance of not pre-pouring meds, even those in bubble packs must be prepared and given one pack and one resident at a time to correct resident. 4/23/22. Licensing specialist spoke with staff 1 on 4/26/22 about following proper procedures when giving meds. Healthcare Oversight will have in-service to address the Five Rights and how they apply to all registered medication aides (RMAs), residents, and medications.
Standard #:	22VAC40-73-680-I
Description:	Based upon documentation and an interview, the facility failed to ensure the MARs for two of two residents reviewed included all required information. Evidence: 1. The May 2022 MAR for resident 1 did not include a diagnosis for Aripiprazole, Fluticasone, Quanfacine and Sertraline; a start date for Levothyroxine; and the as needed (PRN) order for one 1mg tablet Quanfacine. 2. The May MAR for resident 2 was blank on 5/22/2022 at 8:00 am for Clotrimazole 1% Cream and on 5/24/2022 at 8:00 am for Fungoid. 3. On 5/26/2022, the LI interviewed the administrator who stated this information was not included on the May 2022 MAR for resident 1. 4. On 5/26/2022, the LI interviewed both medication aides who stated the medications were administered; however, they had failed to go back and initial the MARs.
Plan of Correction:	Administrator reviewed MARs on 5/26/22 and included a diagnosis for each of resident 1's medications. Administrator also spoke with the pharmacy on 5/26/22 to have them re-enter PRN of Quanfacine 1mg that was removed in error. Administrator and administrative assistant will check MARs and medications when delivered each month and any new orders and make any corrections needed. This process will provide two sets of eyes for review and added protection.