VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Chestnut Grove Home for Adults
786 Chris Barney Road
Dryden, VA 24243
(276) 546-1194

Current Inspector: Crystal Mullins (276) 608-1067

Inspection Date: May 31, 2023

Complaint Related: No

Areas Reviewed:

22VAC40-73 GENERAL PROVISIONS 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

Comments:

Type of inspection: Renewal Date(s) of inspection and time the licensing inspector was on-site at the facility for each day of the inspection: 50/31/2023 Begin: 8:15am End: 2:30pm The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. Number of residents present at the facility at the beginning of the inspection: 84 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 23 Number of staff records reviewed: 9 Number of interviews conducted with residents: 3 Number of interviews conducted with staff: 5 Observations by licensing inspector: Additional Comments/Discussion: 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 Crystal B. Henson Licensing Inspector at 276-608-1067 or by email at crystal.b.mullins@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-640-A
Description:	Based on observations made during the medication cart audit, the facility failed to adhere to their medication management plan for proper disposal of medication. EVIDENCE: 1. For resident # 1, there was a container of Proair HFA (albuterol sulfate), inhale 2 puffs from oral inhaler four times a day if needed for shortness of breath. According to the pharmacy label, the medication was filled on 12/20/2021 and should have been discarded after 12/19/2022. 2. For resident # 2, there was a container of Hollister m9 Odor Eliminator Drops, use 2 drops every 3 days in colostomy for odor. Per the manufacturer, the expiration date was 06/2019. Despite the expiration date on the original container, the pharmacy label indicates it was filled on 08/18/2020. 3. For resident # 3, there was a container of Proair HFA (albuterol sulfate), inhale 2 puffs from oral inhaler four times a day if needed for breathing. Per the manufacturer, the expiration date was 12/2022.
Plan of Correction:	All medications will be monitored weekly by DON and RMA and Discarded appropriately. Corrected on 06/08/2023. [sic]
Standard #:	22VAC40-73-680-D
Description:	Based on observations made during the medication cart audit, the facility failed to administer medications in a manner consistent with the standards of practice outlined in the current medication aide curriculum approved by the Virginia Board of Nursing. EVIDENCE: 1. Latanoprost 0.005 Eye Drops, 1 drop into both eyes at bedtime for resident # 4 had been opened and used but did not contain an open date. 2. Neomycin-Polymyxin-HC Ear Sulfates, 5 drops in left ear every 12 hour(s) as needed fir resident # 5 had been opened and used but did not contain an open date. The mediation was filled on 05/15/2023. 3. Brimonidine 0.2% Eye Drops,1 drop in each eye 2 times a day for resident # 4 had been opened and used but did not contain an open date. The medication was filled on 05/08/2023. 4. Combivent Respimat Inhaler inhale 1 puff into lungs 2 times a day for resident # 7 had been opened and used but did not contain an open date. The medication was filled on 04/12/2023. 5. Fluticas 250/Salmeterol 50 Inhl Disk 60, inhale 1 inhalation from diskus twice daily for resident # 1 had been opened and used but did not contain an open date. 6. Advair 100/50 Diskus, inhale 1 puff into lungs at bedtime for resident # 8 had been opened and used but did not contain an open date. 7. Albuterol Sulfate HFA 90 mcg Inh, inhale 1 puff into lungs every six hours for COPD for resident # 9 had been opened and used but did not contain an open date. 8. Albuterol Sulfate HFA HFA 90 mcg Inh, use 1 puff by mouth every 4 hours as needed wheezing for resident # 10 had been opened and used but did not contain an open date. 9. Fluticasone Prop 50 mcg Spray, inhale 2 sprays in each nostril at bedtime for allergies for resident # 8 had been opened and used but did not contain an open date. The medication was filled on 04/12/2023. 10. Zinc Oxide 20% Ointment, apply to reddened area on buttock 2 times a day as needed after using restroom for rash for resident # 9 had been opened and used but did not contain and open date. The medication was filled on 02/20/2023. 11. Bacitracin 500 Unit/GM Ointment, apply to the affected area to lips three times a day for 10 days for fever blisters for resident # 11 had been opened and used but did not contain an open date. The medication was filled on 05/23/2023. 12. Clobetasol 0.05% Cream, apply twice daily to rash on trunk time 2 weeks for resident # 9 had been opened and used but did not contain an open date. The medication was filled on 05/09/2023. 13. Triamcinolone 0.5% Cream, apply small amount to both hands 2 times a day as needed for rash for resident # 12 had been opened and used but did not contain an open date. 14. Nystatin-Triamcinolone Cream, apply to the affected area at bedtime for rash for resident # 13 had been opened and used but did not contain an open date. The medication was filled on 05/22/2023. 15. Clotrimazole-Betamethasone Cream, apply to buttock area 2 times a day as needed for skin irritation for resident # 14 had been opened and used but did not contain an open date. The medication was filled on 05/26/2022. 16. Diclofenac Sodium 1% Gel, apply 2 gram topically to right knee at bedtime for pain for resident #13 had been opened and used but did not contain an open date. The medication was filled on 04/28/2023. 17. Nystatin 100,000 Unit/GM Cream, apply to affected area three times a day as needed for yeast rash for resident #15 had been opened and used but did not contain an open date. The medication was filled on 03/16/2023. 18. Diclofenac Sodium 1% Gel, apply 4 gram to both knees twice daily as needed for pain for resident # 16 had been opened and used but did not contain an open date. The medication was filled on 05/08/2023. 19. Triamcinolone Acetonide 0.5% Cream, apply small amount to skin twice a day for rash for resident # 12 had been opened and used but did not contain an open date.
Plan of Correction:	All open containers will contain an open date and will be monitored weekly by DON and RMA to make sure this is done. Corrected on 06/08/2023. [sic]
Standard #:	22VAC40-73-860-G
Description:	Based on observations made during the tour of the building, the facility failed to ensure hot water at taps available to residents is maintained within a temperature range of 105-120 degrees Fahrenheit. EVIDENCE: 1. In the women?s common bathroom located between resident rooms 106 and 109, the hot water at the bathroom sink reached a temperature of only 100 degrees Fahrenheit.
Plan of Correction:	Hot water temperatures will be checked weekly and monitored by maintenance to make sure stays within the range of 105-120 Fahrenheit. Corrected on 06/08/2023. [sic]
Standard #:	22VAC40-73-870-A
Description:	Based on a tour of the building, the facility failed to ensure the interior and exterior of all buildings shall be maintained in good repair and kept clean and free of rubbish. EVIDENCE: 1. In the gravel parking area, the LI observed several small empty plastic blister packs. Staff # 1 reported they may have fallen out of a garbage bag when an employee was taking out trash. 2. In the grassy area near the stairs by the front deck, the LI observed a crumpled napkin or paper towel, what appeared to be several very small white bits of paper and several cigarette butts. 3. In the area by the stairs near the front deck, there was a wooden bench that is very worn with large gaps between the slats. Two of the slats were bowing and the bench did not appear to be sturdy. 4. The paint on the ramp leading to the front deck was peeling in several areas.
Plan of Correction:	Maintenance will monitor yards and clean daily and as needed for cig butts and rubbish. Corrected 05/31/2023. [sic]
Standard #:	22VAC40-73-870-B
Description:	Based on a tour of the building, the facility failed to ensure all buildings shall be well-ventilated and free from foul, stale, and musty odors. EVIDENCE: 1. The men?s common bathroom located next to resident room 102 had a strong odor resembling urine when LI walked into the room.
Plan of Correction:	Bathrooms are checked q2 hours and as needed. Corrected 05/31/2023. [sic]
Standard #:	22VAC40-73-870-E
Description:	Based on a tour of the building, the facility failed to ensure all furnishings, fixtures and equipment, including furniture, window coverings, sinks, toilets, bathtubs, and showers, shall be kept clean and in good repair and condition. EVIDENCE: 1. In the shower/bathtub combo in the men?s common restroom by resident room 101, the spigot was covered with white spots and the drain had a dark substance around it, as well as what appeared to be hard water stains. 2. In the same restroom, the first toilet had staining on the back of the toilet seat, a rust colored stain around the pipe on the back of the toilet, dark areas on the floor around the toilet and a soiled piece of crumpled toilet paper to the right of the toilet. 3. The second toilet in the same restroom had large stained areas on the toilet seat, peeling paint and areas of rust behind the toilet and a dark substance on the flooring behind the toilet. 4. The third toilet in the same restroom had dark spots at the base of the toilet and dark stains on the flooring around and behind the toilet, and a dark substance where the baseboard meets the flooring. There was also a significant area of peeling paint on the wall beside the toilet. 5. The urinal in the men?s common restroom located by resident room 102 was filled with a yellow substance appearing to be urine. In the corner of the floor below the urinal, there was a dark substance where the baseboard meets the floor. 6. In the same restroom, there were dark spots on the wall behind the first toilet and a dark ring around the base of the toilet on the floor. 7. In the same restroom, the hot water knob was missing in the shower. 8. The paint on the wall to the left of the sinks and by the door was peeling in the same restroom. 9. In the women?s common restroom between resident rooms 106 and 109, the first stall had a large amount of a brown substance appearing to be feces in the unflushed toilet. The flooring in front of the toilet appeared dirty and stained. 10. In the men?s common restroom by resident room 108, there was a dark substance in the floor in front of and by the base of the first toilet. There was also a brown stain on the wall behind the toilet, just above the baseboard. 11. In the same restroom, the flooring in front of and in the second stall appeared dirty with dark spots. There was a dark substance near the base of the toilet in the same stall. 12. In the same restroom, the third stall had a large amount of a brown substance appearing to be feces in the unflushed toilet. There was a brown substance on the wall behind the toilet and on the floor near the base of the toilet. There was a rust stain around the pipe on the back of the toilet.
Plan of Correction:	Spigot and drain will be changed and monitored by housekeeping and maintenance monthly. Corrected 06/16/2023. Bathrooms will be painted and the tile around the toilets changed. Will be monitored Monthly by housekeeping and maintenance. The toilet seat will be changed. Corrected 06/16/2023. [sic]