VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Bickford of Chesapeake
361 Great Bridge Boulevard
Chesapeake, VA 23320
(757) 819-9500

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

Inspection Date: March 24, 2023

Complaint Related: No

Areas Reviewed:

22VAC40-73 PERSONNEL 22VAC40-73 RESIDENT CARE AND RELATED SERVICES

Technical Assistance:

22VAC40-73-660

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: 03/24/2023 from 11:50 am to 1:30 pm. 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 03/01/2023 regarding allegations in the area(s) of: Part III Personnel and Part VI Resident Care and Related Services. Number of residents present at the facility at the beginning of the inspection: 58 Number of resident records reviewed: 3 Number of interviews conducted with staff: 1 Additional Comments/Discussion: Inspection focused on submitted self-reported incident. An exit meeting will be conducted to review the inspection findings. The evidence gathered during the investigation supported the self-report of non-compliance with standard(s) or law, and violation(s) were issued. Any violation(s) not related to the self-report 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 M. Tess Pittman, Licensing Inspector at (757) 641-0984 or by email at tess.pittman@dss.virginia.gov.

Violations:

Standard #:	22VAC40-73-680-D
Description:	Based on record review and interview, the facility failed to ensure medications be administered in accordance with the physician's or other prescriber?s instructions. Evidence: 1. Resident #1?s order for Tramadol HCL 50 mg tablet indicates to administer one tablet by mouth every 4 hours as need. The February MAR for Resident #1 indicates there were 13 occasions (2/14/23 (1), 2/15/23 (3), 2/17/23 (2), 2/18/23 (1), 2/19/23 (1), 2/22/23 (1), 2/23/23 (2), and 2/25/23 (2)) that Staff #2 documented administering the medication more than once every 4 hours as needed. Resident #2?s order for Oxycodone 5mg tablet indicates to administer one tablet every four hours as needed. The February MAR for Resident #2 indicates there were 70 occasions (2/1/23 (2), 2/2/23 (5), 2/3/23 (1), 2/4/23 (4), 2/5/23 (5), 2/6/23 (9), 2/9/23 (2), 2/14/23 (4), 2/15/23 (5), 2/17/23 (5), 2/18/23 (3), 2/19/23 (7), 2/21/23 (1), 2/22/23 (5), 2/23/23 (5), and 2/25/23 (7)) that Staff #2 documented administering the medication more than once every 4 hours as needed. Resident #3?s order for Tramadol HCL 50 mg tablets indicates to administer one tablet every 6 hours as needed. The February MAR for Resident #3 indicates there were 19 occasions (2/2/23 (2), 2/14/23 (2), 2/15/23 (1), 2/17/23 (3), 2/18/23 (1), 2/19/23 (2), 2/22/23 (2), 2/23/23 (3), and 2/25/23 (3)) that Staff #2 documented administering the medication more than once every 6 hours as needed. 2. Staff #1 acknowledged the MAR indicates medications were not administered in accordance with the physician's or other prescriber?s instructions.
Plan of Correction:	The plan of correction will include weekly audits of all narc meds administered to ensure meds are being administered per order. The audit will be done by the Director of Health and Wellness within 30-days and a quarterly check in with Divisional Director of Health and Wellness to ensure no discrepancies and to include a med management core check.
Standard #:	22VAC40-73-680-J
Description:	Based on record review, the facility failed to document action taken in response to a medication error. Evidence: 1. The MARs of Resident #1, Resident #2, and Resident #3 indicate there were medication errors (the administration of the wrong amount of medication) throughout February; however, the records for Resident #1, Resident #2, and Resident #3 do not indicate action taken as directed by a physician, pharmacist, or a poison control center or notification of the resident's physician of record and family member or other responsible person.
Plan of Correction:	The plan of correction includes updated records to include proper documentation and notifications of contact made to all physicians, POA's.
Standard #:	22VAC40-73-680-K
Description:	Based on record review, the facility failed to obtain from the resident's physician or other prescriber a detailed medication order when medication aides administer the PRN medication. The order should include symptoms that indicate the use of the medication, exact dosage, the exact time frames the medication is to be given in a 24-hour period, and directions as to what to do if symptoms persist. Evidence: 1. Staff #1 was unable to provide a detailed medication order for the following PRN medications: Resident #1?s PRN order for Tramadol HCL 50 mg, Resident #2?s PRN order for Oxycodone 5mg tablet, and Resident #3?s PRN order for Tramadol HCL 50 mg tablets.
Plan of Correction:	The plan of correction includes Health and Wellness Director providing education to the medication aides. The Health and Wellness Director will obtain new orders from residents physician and other prescribers. The orders and details will include symptoms that indicate the use of medications, exact dosages, exact time frames the medication is to be given in a 24-hour period, and the directions as what to do if symptoms persist.