VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Meadow Hills Assisted Living Facility
5046 Williamson Road
Roanoke, VA 24012
(540) 400-7253

Current Inspector: Angela Marie Swink (276) 623-6575

Inspection Date: Dec. 12, 2022

Complaint Related: Yes

Areas Reviewed:

22VAC40-73 ADMINISTRATION AND ADMINISTRATIVE SERVICES 22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-73 RESIDENT ACCOMMODATIONS AND RELATED PROVISIONS 22VAC40-73 BUILDINGS AND GROUND

Technical Assistance:

390-A

Comments:

Type of inspection: Complaint 56557 Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 12/12/2022 from 08:30 AM until 02:00 PM, 02/01/2023 from 10:00 AM until 01:30 PM, and 03/03/2023 from 06:45 PM until 07:30 PM The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. Complaints were received by VDSS Division of Licensing on 12/06, 12/07, and 12/08/2022 regarding similar allegations in the area(s) of: Inconsistent resident accounting, physical plant disrepair, temperatures within the facility, resident neglect and resident care concerns, unmet resident medical needs, inconsistent meals and menus, and staffing issues. Number of residents present at the facility at the beginning of the inspection: The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 4 Number of staff records reviewed: N/A Number of interviews conducted with residents: 3 Number of interviews conducted with staff: 3 Observations by licensing inspector: N/A Additional Comments/Discussion: N/A An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation supported some, but not all of the allegation(s); area(s) of non-compliance with standard(s) or law were: Inconsistent resident accounting, temperatures within the facility, unmet resident medical needs, and inconsistent meals and menus. A violation notice was issued; any violation(s) not related to the complaint(s) but identified during the course of the investigation can also be found on the violation notice. 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 Holly Copeland, Licensing Inspector at 540-309-5982 or by email at holly.copeland@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-290-A
Complaint related:	No
Description:	Based on observation, the facility failed to maintain a written work schedule that includes the names and job classifications of all staff working each shift, with an indication of whomever is in charge at any given time. EVIDENCE: 1. The staff schedules for the weeks of 01/22/2023 through 01/28/2023, 01/29/2023 through 02/04 2023, and 02/05/2023 through 02/11/2023 did not contain an indicator of who was in charge at any given time.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-290-B
Complaint related:	No
Description:	Based on observation, the facility failed to implement its procedure for posting the name of the current on-site person in charge. EVIDENCE: 1. During the 02/01/2023 follow up inspection, LI and collateral 1 observed that the bulletin board listed staff 2 as the current ?Manager on Duty?; however, at the time of inspection, staff 1 was the current manager on duty. 2. During the 03/03/2023 follow up inspection, LI observed that the bulletin board listed staff 2 as the current ?Manager on Duty?; however, at the time of inspection, staff 2 was not working in the facility.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-390-A
Complaint related:	No
Description:	Based on record review, the facility failed to ensure that there shall be a written agreement/acknowledgment notification dated and signed by the resident or the appropriate legal representative, and by the licensee or administrator which includes a description of included services under the auxiliary grant (AG) rate. EVIDENCE: 1. The resident agreement for resident 3, dated 12/03/2020, states that the resident will be charged a monthly fee of $1375.00 in addition to the AG payment which is due on the 1st day of the month. The agreement also states that the monthly charge includes monthly laundry services of $60. 2. Interview with staff 2 indicated that resident 3 is still an AG recipient, but that there is a more current resident agreement which contains the AG rate for laundry services. 3. The more current resident agreement was not located in the record for resident 3 upon record review on 12/12/2022 and 02/01/2023.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-400
Complaint related:	Yes
Description:	Based on record review and interviews, the facility failed to provide to each resident or the resident?s legal representative, a monthly statement that itemizes any charges made by the facility and any payments received from the resident or on behalf of the resident during the previous calendar month and shall show the balance or any credits for overpayment. The facility shall also place a copy of the monthly statement in the resident?s record. EVIDENCE: 1. During the initial inspection, two LIs reviewed records for residents 1 - 4; however, the records did not contain documentation of monthly statements. During the inspection, the LIs requested to see copies of the monthly statements for residents 1 ? 4 from 07/2022 until 12/2022; however, staff 2 was unable to provide the requested documentation. 2. During the follow-up inspection on 02/01/2023, the records for residents 1 ? 4 did not contain documentation of monthly statements. When requested, staff 2 was unable to provide the monthly statements for residents 1 ? 4 from 07/2022 until 02/2023. 3. During the follow-up inspection on 03/03/2023, staff 2 stated that he did not have the monthly statements for residents 1 ? 4 from 07/2022 until 03/2023. 4. On 03/04/2023, LI received an invoice for resident 3 for 01/2023; however, the invoice did not contain an itemized list of charges and payments made by the resident or the facility.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-520-I
Complaint related:	No
Description:	Based on observation, the facility failed to ensure that the current month?s activity schedule shall be posted in a conspicuous location in the facility or otherwise be made available to residents and their families. EVIDENCE: 1. During the 02/01/2023 follow up inspection, LI noted that there was not an activity schedule posted in the facility nor in resident rooms that were visited. 2. During the 03/03/2023 follow up inspection, LI noted that there was not an activity schedule posted in the facility nor in resident rooms that were visited.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-550-F
Complaint related:	No
Description:	Based on observation, the facility failed to ensure that the rights and responsibilities of residents shall be printed in at least 14-point type and posted conspicuously in a public place in all assisted living facilities. EVIDENCE: 1. During the 02/01/2023 follow up inspection, LI noted that the rights and responsibilities of residents were not printed and posted in the facility. 2. During the 03/03/2023 follow up inspection, LI noted that the rights and responsibilities of residents were not printed and posted in the facility.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-610-B
Complaint related:	No
Description:	Based on observation, the facility failed to ensure that the menus for meals and snacks for the current week shall be dated and posted in an area conspicuous to residents. EVIDENCE: 1. During the 02/01/2023 follow up inspection, LI observed that the posted menu for meals and snacks was for the week of 01/22/2023 through 01/28/2023. 2. During the 03/03/2023 follow up inspection, LI noted that there was not a posted menu for meals and snacks in the facility nor in resident rooms that were visited.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-640-A
Complaint related:	No
Description:	Based on resident record review and staff interview, the facility failed to implement a section of its medication management plan. EVIDENCE: 1. The facility?s medication management plan indicates the following: ?No resident will be forced to take any medication. Steps will be taken to avoid missed or refused doses of medications and related adverse reactions. Procedure 1. Missed/refused medications are documented in the resident?s medication record and the prescribing physician notified immediately or according to physician parameters. Physician parameters must be retained in writing and kept on file. 2. Physician instructions regarding missed dose are followed. 3. The administrator or designated staff person re-appraises the resident and contacts the physician and responsible party if the resident is continually refusing a medication(s). if unable to resolve continued refusal, the resident?s relocated from the community may be necessary.? Medication administration records (MARs) for resident 1 from June 2022 through December 12, 2022, contained multiple instances of the resident refusing multiple medications. 2. During an on-site follow up inspection on 02/01/2023, collateral 1 requested that staff 1 provide documentation that indicates that resident 1?s primary physician was made aware of the multiple instances of the resident?s medication refusals from June 2022 through December 12, 2022. Staff 1 informed the LIs that if there was any documentation that the resident?s primary physician had been notified, then the documentation would be in the resident?s observation notes; however, since the resident no longer resides at the facility, she doesn?t have access to his information and that staff 2 will have to obtain the observation notes for the resident. 3. On 03/02/2023, staff 2 provided observation notes from 07/01/2022 through 12/31/2022 which did not contain documentation that the resident?s primary physician had been made aware of the frequent medication refusals. 4. The facility?s medication management plan also indicates the following: ?5. Methods for verifying that medication orders have been accurately transcribed to the MARs. All nurses and medication aides would submit original copies of medication orders to the administrator as soon as they are received at the facility. The administrator who is also the nurse manager would audit the resident?s charts MARs weekly to ensure that all medications ordered for the resident are accurately transcribed to the MAR.? 5. The record for resident 1 contained an electronically signed hospital discharge summary by a physician, dated 12/07/2022, to change the prescribed Basaglar/Lantus insulin to 35 units in the morning and 35 units before bedtime. 6. Alternately, the December 2022 MAR indicates that staff didn?t start administering 35 units of Basaglar in the morning and 35 units of Basaglar at bedtime until 12/11/2022 at 8:00AM even though the resident was discharged back to the facility on 12/07/2022.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-650-F
Complaint related:	No
Description:	Based on resident record review and staff interview, the facility failed to ensure whenever a resident is admitted to a hospital for treatment of any condition, the facility shall obtain new orders for all medications and treatments prior to or at the time of the resident?s return to the facility and the facility shall ensure that the primary physician is aware of all medication orders and has documented any contact with the physician regarding the new orders. EVIDENCE: 1. On 12/12/2022, the record for resident 1 contained a hospital discharge summary, dated 12/07/2022, with change orders for the resident?s prescribed Basaglar/Lantus Solostar insulin, Humalog Insulin, and Olanzapine. 2. During the follow up on-site inspection on 02/01/2023, collateral 1 requested documentation to indicate that resident 1?s primary physician was made aware of the discharge summary, dated 12/07/2022, from the hospital; however, staff 1 informed the LIs that if any documentation existed that the physician was notified, then it would be contained in the resident?s observation notes. Staff 1 added that since resident 1 no longer resides at the facility, she doesn?t have access to those observation notes, so staff 2 will have to obtain and provide those to LI. 3. On 03/01/2023, LI received 07/01/2022 through 12/31/2022 observation notes for resident 1; however, the notes do not indicate that the resident?s primary physician was made aware of the changes on the 12/07/2022 hospital discharge summary.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-680-D
Complaint related:	Yes
Description:	Based on resident record review, the facility failed to ensure medications were administered in accordance with the physician?s or other prescriber?s instructions. EVIDENCE: 1. The record for resident 1 contains a physician?s order, dated 06/29/2022, to continue Melatonin 3MG every night for insomnia; however, the June 2022 medication administration record (MAR) (06/29 and 06/30/2022) and the July 2022 and August 2022 MARs contained documentation that Melatonin 3MG is to be administered to the resident PRN (as needed) and was not administered to the resident every night as the physician?s order indicated. 2. The record for resident 1 contains a physician?s order, dated 08/01/2022, for Novolog insulin 6 units before each meal; however, the August 2022 MAR indicates that the resident was administered 6 units of Humalog (Lispro) insulin before meals between the dates of 08/07/2022 through 08/17/2022. 3. The record for resident 1 contains hospital discharge documentation, dated 09/23/2022, that indicated for the resident to stop taking Metformin 500MG twice daily and start taking Metformin 1,000MG twice daily with meals and to start Lantus insulin 55 units sub-q twice daily; however, the September 2022 (09/24/2022 through 09/30/2022) and October, November and December 2022 MARs for the resident indicate that the resident was not administered the aforementioned changed medication orders. 4. The record for resident 1 contains a physician?s order, dated 10/13/2022, to discontinue Fluoxetine (Prozac) and discontinue Abilify (Aripiprazole); however, the October, November, and December 2022 medication administration records (MARs) for the resident indicate that the two aforementioned medications were still being administered to the resident.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-880-B
Complaint related:	Yes
Description:	880-B.3 Based on observation, the facility failed to ensure a temperature of at least 72 degrees Fahrenheit was maintained in all areas used by residents during hours when residents are normally awake. EVIDENCE: During on-site inspection on 02/01/2023, it was noted by the licensing inspectors (LIs) that the thermostat located in the lobby area to the left of the front door indicated that the temperature was only 67 degrees Fahrenheit.
Plan of Correction:	Not available online. Contact Inspector for more information.
Standard #:	22VAC40-73-880-B
Complaint related:	No
Description:	880-B.2 Based on observation and resident interview, the facility failed to ensure the operation of space heaters was approved by the state or local building or fire authorities. EVIDENCE: 1. During on-site inspection on 02/01/2023, it was noted by the licensing inspectors (LIs) that there was a space heater in Room 4. The resident who occupies Room 4 stated that her room gets cold, especially at night. The resident indicated that staff 2 had given her a space heater to use in her room for heat and that she does use the heater mostly during nighttime because her room gets cold. 2. Interview with staff 1 revealed that it was not known if the space heater was approved for use by the state or local building or fire authorities prior to operation. 3. During the 03/03/2023 follow-up inspection, LI noted an operable space heater in the hallway near room 4.
Plan of Correction:	Not available online. Contact Inspector for more information.