Health inspection·July 11, 2024

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm Based on observations, record review and interview the facility failed to maintain good grooming and personal hygiene for one resident (Resident #62) out of 24 residents sampled, as evidenced by observations of dirt under Resident #62's fingernails. There were 74 residents residing in the facility at the time of survey. Residents Affected - Few The findings included: On 07/08/24 at 9:30 AM Resident #62 was observed lying in bed awake alert, nonverbal and used left upper extremity to gesture. Dirt was observed under Resident # 62's fingernails on the left hand. On 07/11/24 at 8:35 AM Resident #62 was observed lying in bed awake alert and dirt was observed under the fingernails of left hand. Record review of demographic sheet for Resident #62 revealed an admission date of 9/15/2023 with diagnosis that included Hemiplegia and hemiparesis following unspecified cerebrovascular disease affecting right dominant side. Record review of the quarterly Minimum Data Set (MDS) with an assessment reference date of 6/3/2024 Section C for cognitive status revealed a Brief Interview of Mental Status (BIMS) score of 11 out of 15 which indicated moderate cognitive impairment. Section GG for functional abilities and Goals revealed dependent for personal hygiene care. Section E for behaviors revealed no indicators of psychosis. Record review of a Care Plan started on 9/18/23 and revised on 6/5/24 for Resident #62 revealed total care was required to maintain personal hygiene. The interventions included: Aid with oral care, washing, drying face hands, and perineum. Record review of physician orders revealed an order dated 10/25/2023 to check that fingernails are clean and trimmed every day. On 07/11/24 at 8:35 AM, Registered Nurse (RN) Unit Manager acknowledge Resident #62's fingernails are dirty and should have been cut and cleaned. The schedule indicates that residents' nails are to be cut and cleaned on Sundays on the evening shift; the schedule is kept in the CNA's (Certified Nursing Assistants) binder. Record review of a Policy entitled, Giving a Bed bath revised October 2010 revealed Purpose: The purpose of this procedure is to promote cleanliness, provide comfort to the resident and to observe the condition of the resident's skin. 15. Arms and Hands: d. Check the resident's fingernails, nail Page 1 of 4 105005 105005 07/11/2024 Coral Gables Nursing and Rehabilitation Center 7060 SW 8th Street Miami, FL 33144

F 0677 beds, and between the fingers. Provide nail care only when instructed. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 105005 Page 2 of 4 105005 07/11/2024 Coral Gables Nursing and Rehabilitation Center 7060 SW 8th Street Miami, FL 33144

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record review and interview facility failed to ensure that one (Resident #46) out of 24 sampled residents received adequate support services as evidenced by dry and scaly skin on Resident # 46's legs. There were 74 residents residing in the facility at the time of survey Residents Affected - Few The findings include. On 07/08/24 at 8:56 AM Resident #46 was observed lying in bed, the skin of bilateral lower extremity appeared dry and scaly. The resident was constantly rubbing one leg against the other in an up and down motion. On 07/10/24 at 9:55 AM Resident #46 was seated in a wheelchair in the Main dining area, for activities. No distress or rubbing of legs noted. Record review of the demographic sheet revealed Resident #46 was admitted on [DATE] with diagnosis that included: Rash and other nonspecific skin eruption. Review of the Quarterly Minimum Data Set (MDS) with assessment reference date of 5/6/2024 Section C for Cognitive Status revealed a Brief Interview for Mental Status (BIMS) score was 13, out of a scale of 00-15, indicating intact cognition. Section GG for Functional abilities and Goals revealed partial/moderate assistance for eating/oral hygiene/transfer and dependence for toileting/shower. Section M for skin revealed no skin problems. Record review of Care Plan started on 2/2/2024 and revised on 5/8/2024 revealed Resident #46 is at risk for pressure ulcers and skin impairments related to impaired mobility and decline in function. Interventions included: Use moisture barrier (Vitamin A & D Ointment) product as indicated. Report any signs of skin breakdown (sore, tender, red, or broken areas) and Podiatry/Wound care consults as needed. Record review of Electronic Health Record revealed a progress note dated 07/07/2024 that indicated Resident #46's skin was warm and dry to touch, signed by licensed nurse. Further review of Electronic Health Records revealed Certified Nursing Assistant with dates 7/08/24, 7/09/24, and 7/10/24 indicated no skin issues. Record review of Electronic Health Record revealed physician orders dated 2/01/2024: Facility skin care protocol and Skin check every shift during care and report any unusual findings to nurse and 4/12/2024: Weekly skin check once a day on Sundays. On 07/11/24 at 8:44 AM Surveyor asked Staff A, Registered Nurse, (RN) to observe skin of lower extremities of R#46. Staff A, RN brought Resident #46 into the room and evaluated resident's skin. On 07/11/24 at 8:54 AM Staff A, RN stated: I completed a visual skin assessment on [Resident #46] legs and observed dryness, no swelling, and no open area. [Resident #46] denied itching. I will inform the physician. There are no current physician orders pertaining to [Resident #46] legs. The facility protocol is to assess the skin every week for the nurse and the Certified Nursing Assistants (CNA) are to do a daily inspection and to report any change to nursing. 105005 Page 3 of 4 105005 07/11/2024 Coral Gables Nursing and Rehabilitation Center 7060 SW 8th Street Miami, FL 33144

F 0684 Level of Harm - Minimal harm or potential for actual harm Record review of Policy, Pressure Ulcer and Skin Assessment revised September 2013 Purpose: The purpose of this procedure is to provide guidelines for the assessment and identification of residents at risk of developing pressure ulcers. Preparation: 1. Review the resident's care plan to assess any special needs of the resident. Assessment: Monitoring: a. Staff will perform routine skin inspections (with daily care). Residents Affected - Few 105005 Page 4 of 4