VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Chesterfield at Brandermill Woods
2100 Brandermill Parkway
Midlothian, VA 23112
(804) 379-7100

Current Inspector: Kimberly Davis (804) 662-7578

Inspection Date: Feb. 13, 2023

Complaint Related: No

Areas Reviewed:

22VAC40-73 RESIDENT CARE AND RELATED SERVICES

Comments:

Type of inspection: Monitoring Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 2-13-23 from 11:30 a.m.-12:10 p.m. The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. A self-reported incident was received by VDSS Division of Licensing on 1-3-23 regarding allegations in the area(s) of: resident care. Number of residents present at the facility at the beginning of the inspection: 52 Number of resident records reviewed: 1 Number of interviews conducted with staff: 2 An exit meeting was 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 Kimberly Davis, Licensing Inspector at (804) 662-7578 or by email at Kimberly.M.Davis@dss.virginia.gov Violation Notice Issued: Yes A copy of this document will be sent to the licensee/provider for signature.

Violations:

Standard #:	22VAC40-73-680-D
Description:	Based on a self-report from the facility on 1-3-23 and a review of the resident record, the facility failed to ensure that medications shall be administered in accordance with the physician's or other prescriber?s instructions and consistent with the standards of practice outlines in the current medication aide curriculum approved by the Virginia Board of Nursing. Evidence: Physician?s orders for Resident # 1(admit date: 4-29-21) state ?Clonazepam 1 mg tablet every 12 hours for anxiety disorder. Per interview with the facility administrator as well as a review of the Medication Administration Record (MAR) for the resident for the month of December 2022, the facility failed to administer the resident?s Clonazepam (generic for Klonopin) on 12-30-22 and 12-31-22 at 9:00 a.m. and 9:00 p.m. The administrator stated that staff failed to request the resident?s refill in a timely manner and resident did not receive her medication for two days. Administrator also reported that the resident was hospitalized on 1-2-23 due to a seizure. The physician?s progress note in the resident?s record states, ?Seizure occurred this a.m. and lasted about a minute. No prior history of seizures. Patient has not gotten her Klonopin in a few days due to being out of the medicine. ?Seizure ? likely due to benzo withdrawal.?
Plan of Correction:	Not available online. Contact Inspector for more information.