VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Eugene H. Bloom Retirement Center
308 Weaver Avenue
Emporia, VA 23847
(434) 348-4004

Current Inspector: Margaret T Pittman (757) 641-0984

Inspection Date: July 18, 2022 , July 21, 2022 and July 25, 2022

Complaint Related: No

Areas Reviewed:

22VAC40-73 PERSONNEL 22VAC40-73 STAFFING AND SUPERVISION 22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-80 THE LICENSE 22VAC40-73 BUILDINGS AND GROUND

Comments:

Type of inspection: Renewal On 7-18-22 an unannounced renewal inspection was conducted. (AR 07:10/dep 5:45 p.m.) The facility census was 39. The administrator was present, A medication pass observation was conducted, breakfast meal observer, a tour of the facility was conducted, staff and resident interviews and records were reviewed, emergency preparedness documents were reviewed, 48 hours supply observed, first aid kit checked, and other licensing requirements checked during inspection. The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. An exit meeting will be conducted to review the inspection findings. 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 Willie Barnes,, Licensing Inspector at 757-439-6815 or by email at willie.barnes@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-210-B
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure a direct care staff attended at least 18 hours of training annually. Evidence: 1. On 7-18-22, staff #3, had 13.5 hours of annual training. Staff?s date of hire was documented as 5-5-22. 2. On 7-18-22 and 7-25-22, staff #1 acknowledged the aforementioned staff did not have the required 18 hours of training.
Plan of Correction:	all anniversary date to 1 year will be put in training book monthly by assist administrator
Standard #:	22VAC40-73-260-C
Description:	Based on observation and staff interviewed, the facility failed to ensure a listing of all staff who have current certification in first aid or CPR, was posted in the facility so that the information is readily available to all staff at all times. Evidence: 1. On 7-18-22, during a tour of the facility, the inspector inquired where the first aid and CPR posting was located. Staff #1 and #5 stated the listing was not posted. 2. On 7-18-22 and 7-25-22, staff #1 acknowledged the facility did not post the first aid and CPR listing.
Plan of Correction:	Administrator updating our tickler and will be placed in front of scheduled in schedule book. Monthly during updating new monthly schedule will make sure its in place 7/27/22
Standard #:	22VAC40-73-290-B
Description:	Based on observation and staff interviewed, the facility failed to ensure it posted the name of the current on-site person in charge, in a place in the facility that is conspicuous to the residents and the public. Evidence: 1. On 7-18-22, the inspector inquired of staff #1 where the staff person in charge information was posted. Staff stated it was on the staff schedule. Staff #1 was informed that the inspector was not looking for the posted staff schedule but the staff-person in charge posting. 2. On 7-18-22 and 7-25-22, staff #1 acknowledged the staff in-charge posting was not available.
Plan of Correction:	easel at front desk with the charge nurses name on it. Charge nurses will check each other. Administrator will check periodically weekly 7.27.22
Standard #:	22VAC40-73-440-D
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure the uniformed assessment instrument (UAI) was completed as required by 22VAC30-110. Evidence: 1.On 7-18-22, resident #2?s uniformed assessment instrument (UAI) dated 12-9-21 did not have the required signatures. 2. Resident #5?s UAI dated 5-10-22 did not have the required signatures. 3. On 7-18-22 and 7-25-22, staff #1 acknowledged the aforementioned residents? UAIs did not include the required signatures.
Plan of Correction:	Administrator have signed the UAI that designee had done. Administrator will assign assist admin to check over each completion for all signatures. Monthly as administrator update UAI's 7.30.22
Standard #:	22VAC40-73-450-C
Description:	Based on record review and staff interview and the facility failed to ensure the resident?s individualized service plan (ISP) included all assessed needs. Evidence: 1. Resident #5?s uniformed assessment instrument (UAI) dated 5-10-22 documented dressing need as human help/supervision. The individual service plan (ISP) dated 5-10-22 did not include this assessed need. Stairclimbing was assessed as human help/physical assistance. This was not documented on the ISP. 2. Resident #6?s ISP dated 5-11-22 documented resident was pushed in a wheelchair. The UAI dated 5-11-22 did not document wheeling as a need. Resident #1 stated resident use wheelchair for outside the facility, medical appointments. 3. Resident #7?s UAI dated 6-24-22 documented mobility as mechanical help/human help/physical assistance. The ISP dated 6-29-22 did not include this assessed need. 4. Resident #8?s ISP dated 6-30-22 did not include the name of the agency who provides money management for the resident. 5. Staff #1 acknowledged on 7-25-22, the aforementioned residents? ISPS did not include all assessed needs.
Plan of Correction:	#1 reviewed and updated stair climbing on ISP #2 reviewed and updated the wheeling the isp #3 reviewed and updated the isp on the mobility #4 added the agency responsible for sending money management As administrator update Isp I will have assist adm check over and make sure I am not missing any details Aug 1 ,2022
Standard #:	22VAC40-73-450-E
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure the individualized service plan (ISP) was signed and dated by the licensee, administrator, or the designee and by the resident or legal representative, if applicable. Evidence: 1. On 7-18-22, resident #2?s individualized service plan (ISP) dated 12-9-21 was not signed by the resident or legal representative. 2. Resident #4?s ISP dated 1-27-22 was not signed by the resident or legal representative. 3. On 7-18-22 and 7-25-22, staff #1 acknowledged the aforementioned ISPs did not have the required resident/legal representative?s signature.
Plan of Correction:	Administrator have emailed these 2 to the son and they have been brought back in and signed on Aug 2,2002. I explained to son I would be emailing them if he is unable to come in and he said he would read them and send me back an email with him saying he agreed and sign place behind isp.
Standard #:	22VAC40-73-580-A
Description:	Based on document reviewed and staff interviewed, the facility failed to ensure when any portion of the facility is subject to inspection by the Virginia Department of Health, the facility shall be in compliance with those regulations, as evidenced by subsequent annual reports from the Virginia Department of Health. Evidence: 1. On 7-18-22, the facility?s health inspection was last completed on 2-24-20. 2. Staff #1 acknowledged the facility did not have a current health inspection.
Plan of Correction:	Administrator have called health department and left messages. He told me he is coming on phone 7.28.22 Will cont to document but I will have him in community this month.
Standard #:	22VAC40-73-660-A
Description:	Based on observation and staff interviewed, the facility failed to ensure medications was stored in a manner consistent with current standards of practice. Evidence: 1. On 7-18-22 during a tour to facility, the call bell in resident #9?s room was pulled. Staff #6 responded and shown the following medications in the room: (a) Metamucil and Cortizone cream was located on the night stand, (b) Aquaphor cream and Cortizone cream located in the bathroom and (c) Triple antibiotic was located on the dresser. The physician?s order dated 5-1-22 did not include a bedside or self-administration order. 2. On 7-18-22, staff #6 acknowledged, the aforementioned medications were in resident #9?s room. 3. Staff #1 acknowledged the resident?s medication did not have a prescriber?s order and or bedside/ self-administration order.
Plan of Correction:	while licensure was in we received the order for bedside medications and self admin. On admission will make sure orders are done then for self-admission 8.2.22
Standard #:	22VAC40-73-680-D
Description:	Based on record reviewed, observation and staff interviewed, the facility failed to ensure medications was administered in accordance with the physician?s or other prescriber?s instructions and consistent with the standards of practice outlined in the current registered medication aide curriculum approved by the Virginia Board of Nursing. Evidence: 1. On 7-18-22, during the medication pass observation with staff #2, three tablets of resident #3?s Prednisone prescribed for 10 days remained on the medication cart. The July 2022 medication administration record (MAR) documented resident prescribed 2 tablets for 5 days, then 1 tablet for 5 days. The facility received 15 tablets. The MAR noted the medication was first administered on 7-7-22 at 8:00 a.m. and the last dose was administered on 7-16-22 at 8:00 a.m. 2. On 7-18-22, staff #1 and #5 acknowledged there were three tablets remaining on the medication cart on 7-18-22.
Plan of Correction:	Reviewed with all RMAS Rma will report after giving med if more is left in pack, should be reported to charge nurse and admin. Med refresher class is being done this month RN was coming on Aug 4 changed to 1lth of Aug due to she was sick She will be going over this with RMA
Standard #:	22VAC40-73-680-M
Description:	Based on observation, document reviewed and staff interviewed, the facility failed to ensure medications ordered for PRN administration was available, properly labeled for specific resident, and properly stored at the facility. Evidence: 1. On 7-18-22 during the medication pass observation with staff #2, resident #1?s PRN Senna tablet and Clobetasol cream was not available on the medication cart. 2. Resident #3?s Benzocaine cream with a label dated 4-16-20 was on the medication cart. 3. On 7-18-22, staff #1 acknowledged the PRN for resident #1 was not available and resident #3?s PRN medication did not have a current label.
Plan of Correction:	doing monthly checks on carts to make sure prn in meds are on carts. I asked pharmacy when they do their monthly checks they need to check and make sure prn are in place. I have assigned 2 rma to check each month for prn meds are in place 8.1.22
Standard #:	22VAC40-73-700-2
Description:	Based on observation and staff interviewed, the facility failed to ensure it posted the ?No Smoking -Oxygen in Use? sign was posted on the door of any room where oxygen was in use. Evidence: 1. On 7-18-22, during a tour of the facility, resident #2?s room was observed with several oxygen tanks and a concentrator. The door to the room did not have a ?No Smoking- Oxygen in Use? sign posted. The inspector took staff #6 to resident #2?s room who also saw the room door did not have the ?No-Smoking- Oxygen in Use? sign. 2. On 7-18-22, staff #6 acknowledged the aforementioned posting was not on resident #2?s door.
Plan of Correction:	Walk through weekly checking oxygen sign in place on door. Reeducated staff to check each shift that ox signs are always on door with ox in use per administrator
Standard #:	22VAC40-73-940-A
Description:	Based on document reviewed and staff interviewed, the facility failed to ensure it complied with the Virginia Statewide Fire Prevention Code as determined by at least an annual inspection by the appropriate fire official. Evidence: 1. On 7-18-22, the fire inspection report provided to the inspector was dated 1-16-20. 2. Staff #1 acknowledged the facility did not have a current annual fire inspection
Plan of Correction:	Administrator had my fire building inspection with new inspector. he has now put me on his calendar to be done each august 8.2.22
Standard #:	22VAC40-80-120-E-2
Description:	Based on observation and staff interview, the facility failed to ensure the findings of the most recent inspection of the facility was posted . Evidence: 1. On 7-18-22 during a tour of the facility, the most recent inspection posted in the facility was dated 8-21-20. 2. On 7-18-22 and 7-25-22, staff #1 acknowledged the most recent inspection was not posted in the facility.
Plan of Correction:	Administrator monthly will check the bulletin board for mandatory posting are in place. Inspection up to date on board 7.27.22