VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Chestnut Grove Home for Adults
786 Chris Barney Road
Dryden, VA 24243
(276) 546-1194

Current Inspector: Crystal Mullins (276) 608-1067

Inspection Date: June 23, 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 ACCOMMODATIONS AND RELATED PROVISIONS 22VAC40-73 BUILDINGS AND GROUND 22VAC40-73 EMERGENCY PREPAREDNESS

Comments:

Type of inspection: Renewal 6/23/2022 Start: 9:0am-2:3pm licensing inspector was on-site at the facility for each day of the inspection: The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. The evidence gathered during the inspection determined non-compliance with applicable standard(s) or law, and violation(s) were documented on the violation notice issued to the facility. 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 Crystal B. Mullins, Licensing Inspector at 276-608-1067or by email at crystal.b.mullins@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-100-A
Description:	Based on observations made during the medication cart audits, the facility failed to follow the infection control program. EVIDENCE: 1. Resident #19?s glucometer bag was labeled with his name on it, but the glucometer was not labeled.
Plan of Correction:	Label was placed on glucometer day of inspection. D.O.N to monitor. [sic]
Standard #:	22VAC40-73-270-2
Description:	Based on review of staff records, the facility failed to ensure that all direct care staff have received proper restraint training prior to being involved in the care of residents in restraints and a refresher training shall be provided at least annually. EVIDENCE: 1. The most recent restraint training for all direct care staff was completed on 05/08/2020. 2. The facility does have one resident that uses bedrails as a restraint.
Plan of Correction:	Restraint training is scheduled for July 22, 2022. Administrator will monitor training and make sure kept up to date. [sic]
Standard #:	22VAC40-73-490-C
Description:	Based on observations made during the review of resident records, the facility failed to have a health care oversight provided by a licensed health care professional at least every three months by a minimum of a registered nurse. EVIDENCE: 1. Resident #8 has bedrails as a restraint. 2. The last health care oversight for the facility was completed on 03/01/2022 and this was completed by a Licensed Practical Nurse.
Plan of Correction:	drs office has been contacted and drs office will complete oversight every 3 months. [sic]
Standard #:	22VAC40-73-560-E
Description:	Based on resident interviews and resident record review, the facility failed to keep current all resident records. EVIDENCE: 1. Resident #2 states that she is to be scheduled to have a biopsy of a mass located in her throat; there is no documentation available in her file to show there was follow up with the doctor?s office. 2. The nursing notes showed a scan was completed on 04/25/2022 of the area, but no follow up information was documented by the facility until the LI questioned the nursing staff and they contacted the doctor?s office to schedule a consult appointment with the doctor-the appointment was scheduled for July 12, 2022.
Plan of Correction:	Med refresher class scheduled on July 22 DON will monitor charts and documentations monthly and as needed. [sic]
Standard #:	22VAC40-73-680-D
Description:	Based on observations made the facility did not administer medications/treatments consistent with the standards of practice outlined in the current registered medication aide curriculum approved by the Virginia Board of Nursing. EVIDENCE: 1. Resident #18 has a nebulizer machine in his room on the bedside table. 2. At approximately 10:00am the LI found the bulb of the nebulizer to behalf full of a clear liquid.
Plan of Correction:	Will have med refresher inservice on July 22. D.O.N. to monitor. [sic]
Standard #:	22VAC40-73-710-E
Description:	Based on review of resident records, the facility failed to ensure all necessary documentation was present for one resident with the use of restraints. EVIDENCE: 1. Resident #8 uses a half bedrail. The facility did not have a physician?s order for the restraint that had been reviewed by the physician at least every three months.
Plan of Correction:	Dr's office has been contacted. Doctor will review bedrail order every 3 months. [sic]
Standard #:	22VAC40-73-840-B
Description:	Based on observations made during the tour of the building, the facility failed to have immunizations and a regular exam documented by a licensed veterinarian for an animal living on the premises. EVIDENCE: 1. A black cat was located on the outside premises of the facility near the entry door. 2. Staff #12 stated the facility does not allow pets, and that this cat does not have the required immunizations and regular exam documented by a licensed veterinarian
Plan of Correction:	Staff member will take cat home at the end of shift on day of inspection. [sic]
Standard #:	22VAC40-73-870-A
Description:	Based on observations made during the tour of the building, the facility failed to make sure the interior and exterior of the building is maintained in good repair. EVIDENCE: 1. The front deck has paint peeling and the deck boards are uneven creating a trip hazard. 2. The wooden bench on the deck has a board in the middle that is bowed and is coming apart at the end of the board. 3. There are two broken pickets on the railing of the ramp coming off of the deck
Plan of Correction:	1. Deck will be painted and boards corrected to be even. 2. Wooden bench removed from porch. 3. Pickets will be replaced. Maintenance will monitor monthly and make all repairs in a timely manner. [sic]
Standard #:	22VAC40-73-870-B
Description:	Based on observations made during the tour of the building, the facility failed to have all buildings well-ventilated and free from foul, stale, and musty odors. EVIDENCE: 1. On the date of the inspection, 06/23/2022, there was a strong fecal odor observed at 10:10 am near Room W111.
Plan of Correction:	Facility will take extra precaution and continue to make rounds and change/assist residents as needed with toileting. [sic]
Standard #:	22VAC40-73-870-E
Description:	Based on observations made during the tour of the building, the facility failed to keep clean and in good repair all furnishings, equipment, and fixtures including windows, window coverings, sinks, showers, toilets and bathtubs. EVIDENCE: 1. The shower in the women?s common bathroom on W-hall was found to have missing tiles and a black substance around the base of the shower.
Plan of Correction:	Maintenance will replace tile. Base of shower was cleaned and will be re-caulked. Maintenance to monitor monthly and will make repairs in a timely manner. [sic]