VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Commonwealth Senior Living at Cedar Bluff
500 Clinic Drive
Cedar bluff, VA 24609
(276) 596-9750

Current Inspector: Crystal Mullins (276) 608-1067

Inspection Date: May 12, 2022

Complaint Related: No

Areas Reviewed:

VAC40-73 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 ACCOMMODATIONS AND RELATED PROVISIONS ? 22VAC40-73 BUILDINGS AND GROUND ? 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

Comments:

Type of inspection: Complaint Date: 05/12/2022 Start Time:9:15 am Finish Time: 10:15am The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. A complaint was received by VDSS Division of Licensing on (04/06/2022) regarding allegations in the area(s) of :resident care and accommodations. The evidence gathered during the investigation did not support the allegations of non-compliance with standard(s) or law. The inspection summary will be posted to the VDSS website within 5 business days of your receipt of the inspection summary. 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 Crystal B. Mullins, Licensing Inspector at 276-608-1067 or by email at crystal.b.mullins@dss.virginia.gov Violation Notice Issued: No A copy of this document will be sent to the licensee/provider for signature.

Violations:

Standard #:	22VAC40-73-190-C
Description:	Based on review of staff records, the facility failed to ensure all staff were trained as the in charge staff person prior to being placed in charge. EVIDENCE: 1. Staff #4 was hired on 08/10/2020. This staff member works as the in charge staff person from time to time, but no training as to what to do while in charge was documented in her file.
Plan of Correction:	Staff #4 was in-serviced on duties when being in charge and placed in employee file. All staff assigned to be in charge have been in-serviced and placed in employee file. BOM to ensure compliance with new hires. [sic]
Standard #:	22VAC40-73-320-A
Description:	Based on review of resident records, the facility failed to ensure the physical examination of each resident shall include all required elements: EVIDENCE: 1. Resident #6 had a physical for admission dated 04/20/2021. This physical did not include height, weight, and blood pressure, these areas were left blank
Plan of Correction:	Resident #6 was corrected with height, weight and blood pressure that was noted on a separate sheet by the physician. Audit of charts to ensure vital sign information was completed on physical. In-Service RCD/ARCD to ensure physicals are completed to include vital signs by the doctor. [sic]
Standard #:	22VAC40-73-380-A
Description:	Based on review of resident records, the facility failed to include all of the required personal and social information for three residents. EVIDENCE: 1. Resident #1 was admitted to the facility on 3/15/2022. The current behavior and social functioning including strengths and problems were listed as none known on the personal/social data. 2. Resident #6 was admitted to the facility on 04/20/2021. The local department of social services section and the personal/social data sheet does not address any strengths. 3. Resident #8 was admitted to the facility on 09/13/2021. The current behavior and social functioning sections on the persona/social data were listed as none.
Plan of Correction:	Resident #1 personal social data sheet was updated to include strengths. Resident #6 social data sheet was updated to include strengths. Resident #8 personal social data to include current behavior and social functioning section. Audit of charts for personal/social data sheet to be completed. In-service RCD/ARCD to ensure personal/social data sheets are completed. ED or designee will audit new admissions monthly for completed information. [sic]
Standard #:	22VAC40-73-490-D
Description:	Based on review of resident records, the facility failed to include all of the required personal and social information for three residents. EVIDENCE: 1. Resident #1 was admitted to the facility on 3/15/2022. The current behavior and social functioning including strengths and problems were listed as none known on the personal/social data. 2. Resident #6 was admitted to the facility on 04/20/2021. The local department of social services section and the personal/social data sheet does not address any strengths. 3. Resident #8 was admitted to the facility on 09/13/2021. The current behavior and social functioning sections on the persona/social data were listed as none.
Plan of Correction:	Health Care Oversight resident list was completed and now attached. In-service NP or designee on the list of residents that were reviewed during the HCO and information needed. ED or designee will audit q6 months to ensure completion. [sic]
Standard #:	22VAC40-73-640-A
Description:	Based on observations made during the noon medication pass, the facility failed to adhere to their medication management plan regarding the narcotic shift count sheet. EVIDENCE: 1. The narcotic shift count sheet for the assisted living side of the building was not documented and was not signed by the on-coming and off-going staff as the facility?s medication management plan states they will.
Plan of Correction:	Narcotic count sheet was corrected by the staff on duty. Staff in-service on counting of narcotics and to sign the sheet for count being corect on-coming and off-going staff. RCD?ARCD will audit for compliance weekly. [sic]
Standard #:	63.2-100
Description:	Based on observations made during the medication cart audits, the facility failed to ensure proper procedures were implemented and followed regarding the infection control program. EVIDNECE: 1. On medication cart 300, Resident #14 had a glucometer that was not labeled. 2. On medication cart 100, Resident #15 had a glucometer that was not labeled. 3. On medication cart 100, Resident #16 had a glucometer that was not lableled
Plan of Correction:	Resident #14, #15, #16 glucometers were labeled at the time of discovery. Staff in-service on labeling the bag and glucometer of each resident and stored in medication cart. RCD/ARCD or designee will audit carts monthly for compliance. [sic]