VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Carriage Hill Retirement
1203 Roundtree Drive
Bedford, VA 24523
(540) 586-5982

Current Inspector: Jennifer Stokes (540) 589-5216

Inspection Date: Jan. 12, 2022

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-80 COMPLAINT INVESTIGATION

Comments:

Type of inspection: Complaint Date of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 01/12/2022 and 06/13/2022 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 01/09/2022 regarding allegations in the area of resident care and related services. The evidence gathered during the investigation supported some, but not all of the allegations. A violation notice was issued; any violation(s) not related to the complaint 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 violation(s) will be addressed in order to return the facility to compliance and maintain future compliance with applicable standard(s) 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 Jennifer Stokes, Licensing Inspector at 540-589-5216 or by email at Jennifer.Stokes@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-470-A
Complaint related:	No
Description:	Based on resident record review and staff interview, the facility failed to ensure, either directly or indirectly, that the health care service needs of a resident were met. EVIDENCE: 1. The record for resident 1 contained a progress note written by Collateral 3, dated 12/17/2021, with the following statement: ?The skin tears need closer attention and care than the med techs can provide. I am going to order ongoing wound cleaning and light dressings until home health can see the resident. I am going to consult home health for wound management.? 2. The record for resident 1 contained a ?visit note report? from Collateral 4, dated 12/30/2021, with the following statement: ?Spoke to med tech at length that pt (patient) has no need for nursing from home health , as there is no skill. Suggested he be evaluated by hospice.? Licensing inspector spoke with Collateral 4 on 01/27/2022 and Collateral 4 stated that the resident was not picked up for skilled nursing and wound care was not performed by Collateral 4. 3. Resident was admitted to the hospital from the facility on 01/09/2022 and the following consultation note was documented by the hospital dated 01/09/2022: ?He was sent to the emergency department and a very disheveled and poor hygiene condition. He had multiple ulcerations ranging from his scalp all the way down to his lower legs in varying stages of healing both pressure and non-pressure. He also had cellulitis of the right elbow following a abrasion and laceration of the right elbow which required 5 stitches. Apparently the sutures were still in place upon evaluation and admission on 9 January of this year. It was found to have red swollen area around it with purulent drainage. Due to the history of multiple falls and his current condition he was admitted. Wound care was asked to see today in regards to the multiple wounds in varying locations.? and did not return to the facility. During interview with staff 1 during on-site inspection on 06/13/2022, staff 1 confirmed that the record for resident 1 did not contain documentation that the resident had received any ?ongoing wound cleaning and light dressings until home health can see the resident? and also that there was no documentation of any wound cleansing or dressings after the resident was not picked up for skilled nursing on 12/30/2021.
Plan of Correction:	Facility physician provided an order that did not capture his progress note description. Director of nursing and administrator will ensure that physician progress note is reconciled with orders and demand clarifications on vague orders received from any provider when applicable.
Standard #:	22VAC40-73-650-A
Complaint related:	No
Description:	Based on resident record review and staff interview, the facility failed to obtain a valid order from a physician or other prescriber prior to discontinuing a medication, dietary supplement, diet, medical procedure, or treatment. EVIDENCE: 1. Resident 1 was admitted to the facility on 07/15/2021. The record for resident 1 contained an order, dated 07/15/2021, for ?Ensure Plus (chocolate) liquid 240ML drink or give contents of 1 can (240ML) by mouth daily? that was signed by Collateral 2. 2. The July 2021 medication administration record (MAR) for resident 1 from 07/15/2021 through 07/31/2021, the August, September, October 2021 MARs for the resident and the November 2021 MAR from 11/01/2021 through 11/18/2021 did not include documentation that resident 1 had been given Ensure. Interview with staff 1 during on-site inspection on 06/13/2022 confirmed that there was no discontinue order for Ensure for the resident and that there was no documentation that the resident had been given Ensure during the aforementioned time period.
Plan of Correction:	At admission facility received a medication record and H&P that did not have Ensure Plus Liquid order in it, but this medication could be found in resident 1?s separate discharge note. Moving forward, the director of nursing will reconcile all documents including hospital notes, discharge notes, and progress note and send to pharmacy to avoid reoccurrence.
Standard #:	22VAC40-73-650-C
Complaint related:	No
Description:	Based on resident record review and staff interview, the facility failed to ensure a physician?s or other prescriber?s oral order was reviewed and signed by a physician or other prescriber within 14 days. EVIDENCE: The record for resident 1 contained an oral (voice order) by staff 2, dated 08/31/2021 at 1:15PM for the following: ?D/C (discontinue) Lovenox sub-q injections. Start Eliquis 2.5mg tablet PO BID for 7 days for anticoagulant therapy?; however, the order was not signed by a physician or other prescriber. Interview with staff 1 confirmed this was accurate.
Plan of Correction:	Facility has educated licensed nurse that receives voice order on the need to ensure providers/physician/hospice providers signs voice order within 14 days. Director of nursing and administrator will ensure voice orders are signed within 14 days. Resident chats will be flagged until voice orders are signed by physician.