VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Dogwood Crossing Senior Living And Memory Care
130 Deer Ridge Trail
Tazewell, VA 24651
(276) 385-7150

Current Inspector: Rebecca Berry (276) 608-3514

Inspection Date: June 14, 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 22VAC40-90 THE SWORN STATEMENT OR AFFIRMATION 22VAC40-90 THE CRIMINAL HISTORY RECORD REPORT

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: 06/14/2023, 9:45am to 3:39pm 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: 41 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 8 Number of staff records reviewed: 4 Number of interviews conducted with residents: 3 Number of interviews conducted with staff: 2 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 Becky Berry, Licensing Inspector at 276-608-3514 or by email at rebecca.berry@dss.virginia.gov.

Violations:

Standard #:	22VAC40-73-450-C
Description:	Based on a review of resident records, the facility failed to address all identified needs on Individualized Service Plans (ISPs) for three of the eight resident files that were reviewed. EVIDENCE: 1. The uniform assessment instrument (UAI) in the record for resident #1, dated 06/03/2023, identifies transferring, human help only/supervision as a need in which the resident requires assistance; the ISP in the record for resident #1, dated 06/03/2023, states ?resident requires assistance of walker to transfer safely? and does not address the need for supervision. 2. The UAI in the record for resident #6, dated 04/20/2023, identifies bathing, mechanical and human help/physical assistance as a need in which the resident requires help; the ISP in the record for resident #6, dated 04/20/2023, states the resident ?is able to bathe self using grab bars with encouragement from staff? and does not address the need for physical assistance. 3. Based on a physician?s order dated 05/23/2023 and RN visit notes dated 05/29/3023 and 06/06/2023, resident #7 is currently receiving home health services; the ISP in the record for resident #7, dated 08/12/2022, has not been updated to reflect that this service is being provided to the resident.
Plan of Correction:	Facility Administrator and RCD will review all UAIs and ISPs for completeness, correctness, and the UPI?s and ISP?s matches. [SIC]
Standard #:	22VAC40-73-610-B
Description:	Based on observations made during the tour of the building, the facility failed to post the dated menus for meals and snacks for the current week. EVIDENCE: 1. The LI observed the menu that was posted ended May 13, 2023. According to staff #5, the company which prints their menus for them has not provided them with a more current menu at this time.
Plan of Correction:	Facility Administrator and Dietary Manager will review all menus dates for meals and snacks are current for each week. [SIC]
Standard #:	22VAC40-73-650-A
Description:	Based on observations made during the noon medication pass, the facility failed to administer one medication for one resident in accordance with the order from the physician or other prescriber EVIDENCE: 1. Resident #4 was prescribed Tylenol 500mg one by mouth daily at 1pm for pain according to physician?s order dated 06/07/2022. 2. The June 2023 MAR indicates Tylenol 500mg, one by mouth daily is being administered at 9:30am. 3. According to staff #5 resident #4 does receive this medication at 9:30am, not at 1pm as ordered by the physician.
Plan of Correction:	650-A Facility Administrator and RCD to instruct/in-service RMAs to follow administering medications per physicians? orders and order time. [SIC]
Standard #:	22VAC40-73-680-M
Description:	Based on observations made during the noon medication pass, the facility failed to ensure medications ordered for PRN (as needed) administration shall be available and properly labeled for the specific resident, and stored properly. EVIDENCE: 1. Resident #9 was ordered Hemorrhoidal 0.25-14-74.9%, apply to irritated hemorrhoid areas six times a day as needed. This medication was not available to the resident on the date of the inspection.
Plan of Correction:	Facility was waiting on label from pharmacy for medication. Label has been applied by the pharmacy. Inservice for all RMA. [SIC]
Standard #:	22VAC40-73-870-B
Description:	Based on observations made during the tour of the building, the facility failed to keep all buildings well-ventilated and free from foul odors. EVIDENCE: 1. On the green hall around room numbers 307-309 and upon entry into Willow?s Grove, there was a strong foul odor of urine present.
Plan of Correction:	Housekeeping team cleaned area and eliminated odor. Administrator, Housekeeping Manager, or designee will audit building daily to ensure the building is free of odors. [SIC]