VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Dickensonville Assisted Living
80 Yahweh Road
Castlewood, VA 24224
(276) 794-7868

Current Inspector: Crystal Mullins (276) 608-1067

Inspection Date: June 14, 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 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS

Comments:

he 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. or 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

Violations:

Standard #:	22VAC40-73-380-A
Description:	Based on resident record review, the facility failed to obtain all personal and social data prior to or at the time of admission for one resident. EVIDENCE: 1. Resident #3 was admitted to the facility on 11/16/2020. The clergy and second next of kin was left blank on his personal/social data sheet.
Plan of Correction:	Correction has been made on the person/social data sheet. Administrator will ensure this section is not left blank in the future. [sic]
Standard #:	22VAC40-73-480-E
Description:	ased on resident record review, the facility failed to record in the resident record the physician or other prescriber?s orders, services provided, evaluations of progress, and other pertinent information. EVIDENCE: 1. Resident #6 receives wound care two to three times per week due to the diagnosis of wet gangrene and necrotizing fasciitis of right foot diabetic wounds resulting in amputation just below the knee. Home Health provides the wound care but there are no home health notes verifying the care.
Plan of Correction:	Home health agency has provided facility with past patient notices. Administrator will ensure documentation is provided after each visit and left at the facility in the future. [sic]
Standard #:	22VAC40-73-490-D
Description:	Based on the health care oversight review, the facility failed to have documentation of each specific resident for whom the oversight was provided. EVIDENCE: 1. The most up to date health care oversight did not have a list of specific residents for which the health care oversight was provided.
Plan of Correction:	Administrator will have the nurse list specific residents reviewed at the time of the next health care oversight. [sic]
Standard #:	22VAC40-73-520-I
Description:	Based on observations made during the tour of the building, the facility failed to have the current month?s schedule posted in a conspicuous place. EVIDENCE: 1. On the date of the inspection, 6/14/22, the activities calendar downstairs that was posted was dated for May 2022.
Plan of Correction:	Current monthly calendar was posted upstairs for all residents. Old calendar that was downstairs has been removed. [sic]
Standard #:	22VAC40-73-650-A
Description:	Based on observations made during the review of the noon medication pass, the facility failed to have a valid physician?s order for the start or the stop of any medication. EVIDENCE: 1. Resident #9 had a physician?s order dated for 4/19/22 for Trazadone 100mg one by mouth every night, this was not listed on the June 2022 MAR. 2. Resident # 9 had an additional order for Trazadone dated for 4/19/22 which was listed on the June 2022 MAR and showed that she had been receiving the Trazadone 150mg by mouth at bedtime. 3. There was not a discontinue order for the Trazadone 100mg.
Plan of Correction:	D/C order has been obtained for the old prescription and placed in resident chart. Administrator will ensure discontinue orders are current. [sic]
Standard #:	22VAC40-73-650-B
Description:	Based on observations made during the noon medication pass, the facility failed to make sure the physician or other prescribers orders for all drugs shall include the name of the resident, the date of the new order, the name of the drug, route, dosage, strength, how often medication is to be given, and identify the diagnosis, condition, or specific indication for administering each drug. EVIDENCE: 1. Resident # 9is prescribed Fluocinonide 0.05% cream, apply a thin layer to affected areas on lower back twice daily for 2-3 weeks. 2. Resident # 9 is prescribed Hydrocortisone 2.5 % cream, apply twice daily to areas of rash on the neck for up to two weeks. 3. Neither of these orders specified the time used. It was an approximation.
Plan of Correction:	Medication has been completed at this time. Administrator will ensure all future prescriptions have a specific time frame. [sic]
Standard #:	22VAC40-73-680-I
Description:	Based on observations made during the noon medication pass, the facility failed to include all required information on the MAR (Medication Administration Record). EVIDENCE: 1. Resident #7 has Sulfa methoxazole on the June 2022 MAR as a medication that is prescribed by her physician and administered by the facility. The MAR did not contain the strength (mg) of the medication.
Plan of Correction:	The strength of the medication was added to the MAR and the odor has since been completed. The administrator will ensure all medications added to the MAR include the strength. [sic]
Standard #:	22VAC40-73-750-E
Description:	Based on observations made during the tour of the facility, the facility failed to have sufficient bed and bath linens in good repair so that the resident may always have clean linens. EVIDENCE: 1. Room #7 was observed to have a bed to the left of the room when you walk in, this bed had sheets that appeared dirty, worn, and had brown spots on them.
Plan of Correction:	Bed sheet was clean but stained. Bed sheet has been thrown away. [sic]
Standard #:	22VAC40-73-870-A
Description:	Based on observations made during the tour of the building, the facility failed to have the interior and exterior of the building maintained in good repair and kept clean and free of rubbish. EVIDENCE: 1. The deck off the side of the downstairs common area was found to have a soda bottle and plastic wrappers scattered about the surface.
Plan of Correction:	Disposed of soda bottle. Was unable to locate plastic wrappers. Grounds will continue to be checked daily for litter by administrator. [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 must odors. EVIDENCE: 1. Room #11 had a very strong odor similar to the smell of dirty feet.
Plan of Correction:	Resident in Room #1 showers regularly but refuses to wear socks with his shoes. Will attempt to get a prescription for odor spray for shoes for resident to use in the future. [sic]
Standard #:	22VAC40-73-870-E
Description:	Based on observations made during the tour of the facility, the facility failed to make sure all furnishings are kept clean and in good repair. EVIDENCE: 1. The white bench outside near the gate at the fence was no longer white in color, it was covered with dirt and green colored stain. 2. The purple and white flowers on the right side ramp are quickly overgrowing and could present a trip hazard if not trimmed.
Plan of Correction:	1. Bench has been replaced. Maintenance will replace outdoor furniture as needed. 2. Flowers have been trimmed. Maintenance will ensure flower/plants outside are pruned. [sic]