VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Riverside Assisted Living at Patriots Colony
6200 Patriots Colony Drive
Williamsburg, VA 23188
(757) 220-9000

Current Inspector: Willie Barnes (757) 439-6815

Inspection Date: Dec. 12, 2023 , Jan. 29, 2024 and Feb. 2, 2024

Complaint Related: Yes

Areas Reviewed:

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 22VAC40-80 COMPLAINT INVESTIGATION

Comments:

Type of inspection: Complaint An unannounced complaint inspection was conducted on 12-12-23. Ar 10:42 a.m./ Dep 13:25 p.m. The Acknowledgement of Inspection form was signed and left at the facility for each date of the inspection. A complaint was received by VDSS Division of Licensing on 10-25-23 regarding allegations in the areas of resident care and related services. Number of residents present at the facility at the beginning of the inspection: Census 63 The licensing inspector completed a tour of the physical plant that included the building and grounds of the facility. Number of resident records reviewed: 1 Number of staff records reviewed: 0 Number of interviews conducted with residents: 0 Number of interviews conducted with staff: 8 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 some, but not all of the allegation; area(s) of non-compliance with standard(s) or law A violation notice was issued; any violation(s) not related to the complaint 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 (Willie Barnes), Licensing Inspector at (757) 439-6815 or by email at willie.barnes@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-450-F
Complaint related:	Yes
Description:	Based on record reviewed and staff interviewed, the facility failed to ensure the resident?s individualized service plan (ISP) was reviewed and updated. Evidence: 1. On 12-12-23, during a complaint inspection, resident #1?s individualized service plan (ISP) provided to the inspector by staff #1 was not updated. The target date for the resident?s goals were dated 3-31-23. The resident?s progress notes documented cognitive changes for the resident. The facility?s 72-Hour Summary also documented cognitive changes. The resident?s Progress notes documented the following: (a) On 12-21-22 at 12:01, staff was assisting resident with shower, when staff observed resident removing undershirt and disposed of the shirt in the toilet and closed the lid. Staff removed the shirt from toilet. (b) On the morning of 12-24-22 at 12:06, it was noted, the resident was walking towards the entrance of the building with a coat on and only an underdress slip underneath. It was noted resident stated going out with family and that is what resident wanted to wear. Note documented several staff members tried reasoning with resident because of what resident was wearing and the extreme cold temperature. (c) On 1-3-23, resident observed attempting to go to the dining room in a cardigan and night gown and not wearing any undergarments. Staff tried to reason with staff regarding dressing appropriately for the dining room. Resident did change outfit. (d) 1-16-23 noted facility staff communicating with resident?s POA, the resident?s service plan and level of care reviewed via telephone. The note indicated, due to continued and steady cognitive decline, resident is requiring more care needs to be meet by staff. Level of care was increased to a 83 for this reason. POA voiced understanding and also stated noticing the cognitive decline. (e) On 2-6-23 at 11: 53, resident observed attempting to enter the dining room in a bathrobe and night gown, redirected to go back upstairs to dress appropriately. (f) On 6-1-23, staff contacted family member to discuss staff concerns, resident refusing to wear or change briefs and not wanting to dirty laundry or linens to be washed, voice message left. (g) On 7-31-23 at 06:18, staff documented resident came to nurse?s station at 0030 and was confused about time and making remarks that did not make sense. Resident came again at 03:15, when asked, resident denied having trouble sleeping. Resident stated wanting to go downstairs and see ?how it is outside?. Resident returned to 10 minutes later but did not sleep and was awake. (h) 9-6-23, staff noted, resident confused but calm and cooperative. (i) 9-9-23 staff noted, resident showing more signs of confusion or not comprehending; did not remember that resident usually get a croissant for breakfast daily and eats in room. (j) 9-13-23, resident did not know what resident?s key was or how to use; resident seems more confused than normal. (k) On 9-16-23 at 06:32, staff noted resident showing increased confusion, came to nurse?s station three times asking the same question. Resident also wandering around unconvinced about the time of day; went to check if breakfast was being served at 23:30. (l) On 9-16-23 at 18:58, staff documented, resident dementia is worsening. Resident is not eating; staff in the dining room report having to cue resident to eat. Resident takes one bit than voice being full. Resident unaware of time anymore, continuously going to the dining room asking for lunch all times of the day. (m) On 9-24-23, resident not aware of bowel movement in brief, resident changed by staff and assisted with night clothes and prepare for bed. (n) On 10-1-23 staff noted resident required extensive encouragement for all 3 meals; drank small amount of boost and ate small bites of meals.
Plan of Correction:	1. Resident #1 no longer resides in the facility as of October 4, 2023. 2. All residents' ISP's will be audited to ensure that any cognitive changes, weight loss and any changes in care needs are updated accordingly. 3. Administrator/designee will educate the clinical staff on ensuring the ISPs include all cognitive changes, weight loss and any changes in care needs and services to be provided. 4. Administrator/designee will audit 4 charts weekly for 8 weeks to ensure the ISPs include any cognitive changes, weight loss and assessed needs in the resident's condition. The results of the audit will be reported to the clinical operations report for evaluation of compliance and ongoing monitoring for continuous improvement. 5. All corrective actions will be completed by March 29, 2024.