Bickford of Chesterfield

Based on the review of facility records and interviews conducted the facility failed to ensure that the cognitive impairment training for staff was conducted by a licensed health care professional practicing within the scope of his profession who has at least 12 hours of training in the care of individuals with cognitive impairments due to dementia; or a person who has been approved by the department to develop or provide the training.

Based on the review of facility records the facility failed to ensure that reassessments due to a significant change in the resident's condition, using the UAI, was utilized to determine whether a resident's needs can continue to be met by the facility and whether continued placement in the facility is in the best interest of the resident.

Based on the review of facility records, interviews conducted and department records the facility failed to ensure that for a facility licensed for both residential and assisted living care, the administrator, who is licensed as an assisted living facility administrator or nursing home administrator by the Virginia Board of Long-Term Care Administrators, may be responsible for the day-to-day administration and management of multiple facilities under the following conditions:

Based on the review of facility records the facility failed to ensure that the Individualized service plans were reviewed and updated at least once every 12 months and as needed for a significant change of a resident’s condition.

Based on the review of facility records the facility failed to ensure that facility Medication Administration Records (MARs) included any medication errors or omissions.

Based on the review of facility records the facility failed to ensure that orientation and training required about compliance with regulations for assisted living facilities as it relates to their duties and responsibilities occurred within the first seven working days of employment.

Based on correspondence with the facility, the review of facility records and interviews conducted the Licensee failed exercise general supervision over the affairs of the licensed facility and establish policies and procedures concerning its operation in conformance with applicable law, this chapter, and the welfare of the residents.

Based on the review of facility records the facility failed to ensure that the use of PRN medications is prohibited, unless one or more of the allowed conditions exist.

Based on the review of facility records the Licensee failed to ensure compliance with all regulations for licensed assisted living facilities and terms of the license issued by the department; with relevant federal, state, and local laws; with other relevant regulations; and with the facility's own policies and procedures.

Based on the review of facility records the facility failed to ensure that resident’s record contained the physician's or other prescriber's signed written order or a dated notation of the physician's or other prescriber's oral order. Orders shall be organized chronologically in the resident's record.

Based on observation and interviews conducted the facility failed to ensure that special environmental precautions are taken by the facility to eliminate hazards to the safety and well-being of residents.

Based on the review of emails received at the department and interviews conducted the facility failed to immediately notify the Virginia Board of Long-Term Care Administrators and the department's regional licensing office that the licensed administrator resigned, and that a new licensed administrator has been employed or that the facility is operating without an administrator licensed by the Virginia Board of Long-Term Administrators, whichever is the case, and provide the last date of employment of the previous licensed administrator.

Based on the review of facility records the facility failed to ensure that at all times the department's representative is afforded reasonable opportunity to inspect all of the facility's buildings, books, and records and to interview agents, employees, residents, and any person under its custody, control, direction, or supervision as specified in § 63.2-1706 of the Code of Virginia.

Based on the review of facility records and interviews conducted the facility failed to ensure that the facility implemented a written plan for medication management.

Based on the review of facility records and interviews conducted the facility failed to ensure that Physician or other prescriber orders, both written and oral, for administration of all prescription and over-the-counter medications and dietary supplements shall include the name of the resident, the date of the order, the name of the drug, route, dosage, strength, how often medication is to be given, and identify the diagnosis, condition, or specific indications for administering each drug.

Based on the review of facility records and interviews conducted the facility failed to ensure that medications were administered in accordance with the physician's or other prescriber's instructions and consistent with the standards of practice outlined in the current registered medication aide curriculum approved by the Virginia Board of Nursing.

Based on the review of facility records and interviews conducted the facility failed to ensure that the use of PRN medications is prohibited, unless: The resident is capable of determining when the medication is needed; when the facility has obtained from the resident's physician or other prescriber a detailed medication order that included 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 the symptoms persist. Resident #2 The resident’s physician’s orders charting for March and April 2021 that was submitted for the inspector’s review notes the following-“Oxycod /APSP tablet 7.5-325. Take one table by mouth twice daily as needed for pain ”Max 4GM APAP/24H? ' It is documented on the facility’s medication administration record (PRNs page) charting for March 2021 that was submitted for the inspector’s review that facility registered medication aides administered the medication OXYCOD to resident # 2 ?twenty (20) different times. ' Facility medication administration records (MARs) charting for April 2021 that was submitted for the inspector’s review revealed the following for the medication OXYCOD: 11-7 SHIFT: Two different facility registered medication aides documented that the medication OXYCOD was administered to resident # 2 for pain on eleven (11) different times. 7-3 SHIFT: Facility registered medication aides documented that the medication was administered to resident #2 five different days for the month of April during the 7-3 shift. 3-11 SHIFT: During the month of April 2021, facility registered medication aides documented on the facility’s MAR -Pass Notes document that the medication OXYCOD was administered to resident #2; thirty-eight (38) times beginning 04/01- 27/2021. During the 05/14/2021 telephone interview the facility Administrator stated that resident #2 ask for the medication because of pain. However, upon request the facility did not submit for the inspector’s review documentation of the resident’s request for the pain medication OXYCOD on any of the days that the registered medication aides documented that they administered the medication to the resident in March and April 2021. RESIDENT #3- The facility did not submit upon request facility nurses/progress notes or any other facility documentation that the facility’s registered medication aides received written guidance from the resident’s physician prior to administering the 50 mg tablet of the medication Trazodone to the resident.

Based on the review of facility records and interviews conducted the facility failed to ensure that the use of chemical restraints were prohibited. Resident #2 -Documented date of admission 01/14/2019 The facility’s March and April 2021 physician’s order that was submitted for the inspector’s review via a fax on 05/14/2021 notes for the medication (1)-QUETIAPINE-Tab 25MG: Take ? tablet 12.5MG by mouth twice daily as needed or Severe Psychosis (Paranoia, Hallucinations and/or Delusion) or Agitation; (2)- -?Oxycod /APSP tablet 7.5-325. Take one table by mouth twice daily as needed for pain “Max 4GM APAP/24H” Facility registered medication aides documented on the March and April 2021 MAR-Pass Notes document that the medications Quetiapine and OXYCOD were administered to resident #2 on the following days and the reason why: ? 03/20/2021 at 9:28 p.m. facility registered medication aide documented that she administered one 7.5-325mg tablet of the medication Oxycod to the resident for pain. The same registered medication aide also documented that she administered one 25mg tablet of the medication Quetiapine to the resident at this same time for Insomnia; the medication is prescribed for severe psychosis. The registered medication aide over medicated the resident by administering 25mg instead of ? of the 25mg as prescribed by the physician. The registered medication aide also administered the PRN medications to resident #2 without written instructions from the prescribing physician prior to administration ? The next day; 03/21/2021 and again during the 3-11 shift the same registered medication aide noted at 8: 15 p.m. that she administered one 7.5-325mg tablet of the medication Oxycod to the resident for pain. The same registered medication aide also documented that she administered one 25mg tablet of the medication Quetiapine to the resident at this same time again for Insomnia. ? 04/04/2021 at 7:20 p.m. facility registered medication aide documented that she administered one 7.5-325mg tablet of the medication Oxycod to the resident for pain. The same registered medication aide also documented that she administered one 25mg tablet of the medication Quetiapine to the resident at this same time for Insomnia. ? 04/23/2021 at 7:40 p.m. facility registered medication aide documented that she administered one 25mg tablet of the medication Quetiapine to resident #2 for Pain; the medication is prescribed for severe psychosis. ? The review of the facility’s MARs and physician’s orders charting for April 2021 revealed that facility staff #4 over medicated resident #2 approximately fourteen (14) times when she administered one-25mg tablet of the PRN medication Quetiapine instead of ? a tablet of the 25mg PRN medication. Upon request the facility submitted no documentation of any observed or assessed behaviors of the resident exhibiting severe psychosis; requesting pain medication or whether attempts were taken to avoid the chemical restraint, and whether alternatives were used instead.