VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Green Valley Commons Assisted Living
549 Valley Mill Road
Winchester, VA 22602
(571) 359-1499

Current Inspector: Sarah Pearson (540) 680-9469

Inspection Date: Dec. 19, 2023

Complaint Related: No

Areas Reviewed:

22VAC40-73 RESIDENT CARE AND RELATED SERVICES

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: LI entered the facility at 1:00 pm on 12/19/2023 and exited at 2:25 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 12/6/2023 regarding allegations in the area(s) of resident care and related services. Number of resident records reviewed: 1 Number of staff records reviewed: 1 Number of interviews conducted with residents: 0 Number of interviews conducted with staff: 1 Observations by licensing inspector: Additional Comments/Discussion: 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 Jamie Eddy, Licensing Inspector at (703) 479-5247or by email at jamie.eddy1@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-680-D
Description:	Based upon a review of records and interviews, the facility failed to ensure that medications were administered in accordance with the physician?s or other prescriber?s instructions. Evidence: 1. During a focused monitoring inspection conducted on 12/19/2023, LI reviewed caregiver notes written by Staff 1 for Resident 1 that stated: ?At 10 pm (12/6/2023) I gave resident her scheduled 20 units of Glargine, but also thought she got her ASPART. I took her BG (blood glucose) it was 189, I gave her 6 units. She was not to get ASPART as I gave her 8 units at 8 pm.? 2. According to interview with Staff 1 conducted at approximately 2:15 pm on 12/19/2023, Staff 1 admitted to giving Resident 6 units of ASPART at approximately 10 pm on 12/6/2023. Staff 1 indicated she realized she made a mistake when she went to document the medication administration and immediately notified the Executive Director. 3. The Medication Administration Record (MAR) for Resident 1 states that ASPART is to be administered at 8 pm.
Plan of Correction:	All med techs were educated on medication management, and medication administration on December 12, 2023, a test was included. Staff 1 was given a written warning and probation period of 30 days. The administrator will assume responsibility for correction and future compliance. She will coordinate training with the nurse consultant for the facility. All training will be documented and maintained in the staff record. Correction to begin immediately with all staff having completed training. Person responsible for implementation: the administrator