VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Riverside Assisted Living at Warwick Forest
860 Denbigh Blvd.
Newport news, VA 23602
(757) 886-2000

Current Inspector: Willie Barnes (757) 439-6815

Inspection Date: Feb. 2, 2023 , Feb. 3, 2023 and Feb. 16, 2023

Complaint Related: No

Areas Reviewed:

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 22VAC40-90 BACKGROUND CHECKS FOR ASSISTED LIVING FACILITIES 22VAC40-90 THE SWORN STATEMENT OR AFFIRMATION 22VAC40-90 THE CRIMINAL HISTORY RECORD REPORT

Comments:

Type of inspection: Renewal An unannounced renewal inspection was conducted on-site on 2-2-2023 (ar 07:35/dep 4:25p.m) and 2-3-2023 (ar 09:35/dep 1:15 p.m). The facility census on 2-2-2023 was 118, a tour of the facility was conducted, a breakfast meal observed on 2-2-2023, medication pass observation conducted on 2-3-2023, emergency preparedness observed on 2-3-2023, resident and staff records reviewed, and staff and resident interviews conducted. An exit meeting was conducted on both days of the inspection with the unit manager on day 1 and the administrator on day 2. The Acknowledgement form was signed and dated on both days following the preliminary exit meeting. 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) 439-6815or by email at willie.barnes@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-380-B
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure the personal and social information document with the required information per the regulation was kept current for four of ten residents. Evidence: 1. Residents #1?s personal social data documented ?none? for allergies. The resident?s January 2023?s physician order sheet documented resident allergic to Codeine. 2. Resident #3?s social data did not include the resident?s date of admission. 3. Resident #6 and #7?s social data forms did not list the residents? date of admission. 4. Resident #7?s social data form did not include the resident?s know allergies noted on the resident?s physical examination document. 5. Staff #1 and #2 acknowledged the resident?s personal and social data document in the record did not include the date of admission and updated advance directive information.
Plan of Correction:	1. Resident #1, #2, #3, #6 and Resident #7 social information document has been updated with the required information per the regulation. 2. Unit Managers/designees will review 100% of current resident Social Data documents to validate that all have been updated to reflect the current information. 3. The Nurse Educator/designee will provide training to all Nurses, Medication aides and CNAs regarding the regulatory guidelines for Social Data Information. 4. The Administrator/Designee will audit five resident's annual Social Data Sheets monthly for 3 months to ensure all updates are addressed. Completed actions will be submitted to the QA Committee for analysis and recommendations
Standard #:	22VAC40-73-440-K
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure the uniformed assessment instrument (UAI) was completed as required for three of ten residents. Evidence: 1. On 2-2-23, resident #3?s UAI dated 5-2-22 was completed by a facility staff, however, the administrator or designee did not signify approval with signature and date. 2. Resident #5?s UAI dated 8-27-22 and resident #7?s UAI dated 5-2-22 did not contain a signature of the administrator or administrator?s designee. 3. 3. Staff #1 and #2 acknowledged the aforementioned residents? UAI were not completed as required.
Plan of Correction:	1. Resident #1, #2, #3, #6 and Resident #7 social information document has been updated with the required information per the regulation. (2/3/23) 2. Unit Managers/designees will review 100% of current resident Social Data documents to validate that all have been updated to reflect the current information. (3/1/23) 3. The Nurse Educator/designee will provide training to all Nurses, Medication aides and CNAs regarding the regulatory guidelines for Social Data Information. 4. The Administrator/Designee will audit five resident's annual Social Data Sheets monthly for 3 months to ensure all updates are addressed. Completed actions will be submitted to the QA Committee for analysis and recommendations
Standard #:	22VAC40-73-450-C
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure the individualized service plan (ISP) included all assessment needs for four of ten residents. Evidence: 1. Resident 1?s admission?s physical dated 5-18-22 documented physical therapy/ Occupational therapy (PT/OT) evaluation. The resident?s record documented PT services 6-28-22, start of care and discharged on 8-26-22. The uniformed assessment instrument (UAI) dated 5-5-22 documented medication administered by facility staff. A physician?s order dated 8-26-22 documented resident, ?may keep at bedside and self-administer Latanoprost.? Resident?s order review history report printed on 2-2-23 also documented ?may keep at bedside and self-administer?. The ISP dated 5-5-22 did not include these assessed needs. 2. Resident #2?s uniformed assessment instrument (UAI) dated 1-24-23 documented transfer need assessed as mechanical help/supervision. The ISP documented, ?use of arm of chairs, grab bars or assistive devices?? During medication pass with staff #4, the private sitter requested staff assist the resident with breathing concerns. The private sitter was observed by the inspector in the resident?s room on the morning of 2-2-23. The facility medication review report dated 2-21-23 noted Metamucil Fiber and Calcium Carbonate chew ?may keep at bedside? and self-administer Metamucil. The UAI dated 1-26-23 documented medications administered by facility staff. These services were not addressed on the ISP with a target dated of 2-12-23. There was no date on the ISP. 3. Resident #3?s UAI dated 5-2-22, dressing assessed as mechanical help. The ISP did not document a mechanical device. The facility?s nursing assessment documented resident?s use of hearing aids. This need is not on the ISP. The ISP documented resident does not need help for hypertension and blood factors. The resident is prescribed Lisinopril and Plavix. Resident?s fall risk score was 10 (high) per the facility?s form. Resident?s risk for fall not on the ISP. 4. Resident #4?s UAI dated 1-18-23, bathing assessed as mechanical help/physical assistance (mh/pa), the ISP noted staff washes resident and encourage to assist. Toileting assessed as mh/supervision; the ISP noted mh only. Transferring assessed mh/s, the ISP noted help mechanical. Stairclimbing assessed mh, the ISP noted mh/s. Bladder assessed as incontinent external device/not self-care. The ISP noted mechanical and human physical help. 5. Staff #1 and #2 acknowledged all assessed needs for the aforementioned residents were not addressed on the resident?s ISP.
Plan of Correction:	1. Resident #1, #2, #3 and Resident #4s ISP and UAI were updated to include all assessed needs and services. (2/6/23) 2. Unit Managers/designees will review 100% of current resident records to validate UAls and ISPs consistently address the individualized needs of each resident. 3. Nurse Educator/designee will provide refresher training on the UAI/ISP completion and review process. 4. The Administrator/Designee will randomly audit five residents' UAI and ISP monthly to ensure compliance and all needs are reflected on the UAI and ISP. Completed actions will be submitted to the QA Committee for analysis and recommendation. (3/31/2023) Ongoing
Standard #:	22VAC40-73-450-E
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure the individualized service plan (ISP) shall be signed and dated by the licensee, administrator or designee and the resident or legal representative for one of ten residents. Evidence: 1. On 2-2-23, resident #3?s ISP with an end dated of 5-31-23 did not include the date and signature of the resident and/or legal representative. 2. Staff #2 acknowledged the aforementioned resident?s ISP was not signed by the resident and/or representative.
Plan of Correction:	1. Resident #3 have been re-issued to the legal representative for signature. Documentation of the correspondence has been noted and a record kept on file. (3/1/2023) 2.Resident #1, #2, #3 and Resident #4s ISP and UAI were updated to include all assessed needs and services. 3. Unit Managers/designees will review 100% of current resident records to validate UAls and ISPs consistently address the individualized needs of each resident. 4. Nurse Educator/designee will provide refresher training on the UAI/ISP completion and review process. 5. The Administrator/Designee will randomly audit five residents' UAI and ISP monthly to ensure compliance and all needs are reflected on the UAI and ISP. Completed actions will be submitted to the QA Committee for analysis and recommendation.
Standard #:	22VAC40-73-680-M
Description:	Based on observation, record review and staff interviewed, the facility failed to ensure medications ordered for PRN administration shall be available, properly labeled for the specific resident, and properly stored at the facility. Evidence: 1. On 2-2-23 during medication pass observation, with staff #4, resident #1?s PRN Lidocaine cream was not available. 2. Resident #2?s Promethazine, Colace and Tylenol were not available. 3. Staff #1 acknowledged the aforementioned residents? PRN medication should have been available.
Plan of Correction:	1. Resident #1 and Resident #2's PRN medication was ordered and is on hand. 2. The Nurse Managers will educate all LPNs and Medication Aides on the ensuring that all PRN medication are on hand for residents. Education to be documented. 3. The Nurse Educator/Designee will educate all nurses and medication aides on the importance of having all medication on hand per state guidelines. 4. The Nurse Managers/designee will conduct an audit of all PRN medication orders monthly for three months to validate LPN/MA compliance and understanding. All completed actions will be submitted to the QA Committee for analysis and recommendation.
Standard #:	22VAC40-73-720-A
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure the Do Not Resuscitate (DNR) order was included on the Individualized Service Plan (ISP). Evidence: 1. Resident #7?s most recent ISP with a review date of 12-15-22 did not include the resident?s DNR dated 11-10-22. 2. Staff #1 acknowledged the aforementioned resident?s ISP did not include residents DNR information.
Plan of Correction:	1. Resident #7's Individualized Service Plan has been updated to reflect Do Not Resuscitate (DNR). 2. A complete audit of Code Statuses on all current residents will be completed to ensure compliance. All Individualized Service Plans will be updated if needed. 3. The Administrator/designee will educate the nursing leadership as well as the recreation therapy team on required updates to ISPs. (2/28/2023) 4. Nurse Manager/AL Manager or designee will conduct quarterly audit of ISPs and Code Status to ensure both are complying. Completed actions will be submitted to the next QA Committee for analysis and recommendation. (Ongoing)