Health inspection·December 15, 2022

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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to provide assistance during dining observation for 1 (Resident #293) of 6 residents reviewed for nutrition. Residents Affected - Few The findings included: In an observation conducted on 12/12/22 at 1:00 PM, Resident #293 was noted in her room with the lunch tray. The lunch tray was observed to be 100% untouched, and no staff was noted in the room. Continued observation at 1:25 PM showed no staff in the room assisting Resident #293 with her lunch meal. In an observation conducted on 12/13/22 at 8:03 AM, Resident #293 was noted in her room with the breakfast tray in front of her. The tray was set up, and some of the food was cut into smaller pieces, but no staff was noted in the room. It was noted that 50 % of the [brand] nutritional supplement was 50% consumed. The food on the tray was noted to be 100% untouched. At 8:17 AM, showed Staff in the room standing over Resident #293, asking her if she wanted to eat. At 8:18 AM, Staff noted walking out of the room, and the food on the tray was still 100% untouched. Continued observation showed that at 8:28 AM, the tray was still 100% untouched with no staff assistance in the room. (Photographic evidence obtained) A chart review showed that Resident #293 was admitted on [DATE] with diagnoses of dysphagia, muscle weakness, and acute kidney failure. The Minimum Data Set (MDS) dated [DATE] showed that Resident #293 had a Brief Interview of Mental Status (BIMS) score of 03, which is severely cognitively impaired. It further showed that under eating in Section G, Resident #293 needs extensive assistance with one person assists during dining. A Physician order noted for a Mechanical Soft/Ground texture, Thin Fluids consistency, for Diet/Nutrition dated 12/01/22, and at risk for Malnutrition dated 11/14/22. A Mini Nutritional assessment dated [DATE] showed that Resident #293 is malnourished. The Nutrition Risk assessment dated [DATE] showed that Resident #293 had a weight loss before her admission to the facility. It further showed that Resident #293 had a 50% intake of meals with supervision to total assistance. Resident #293's fluid intake did not meet her estimated needs, and her food intake met 60% of her estimated needs. A review of the Dietary note dated 12/09/22 showed Nursing reports poor appetite x (times)1 week and that Resident #293 is with 100% intake of supplements and 0% intake at meals. Page 1 of 4 105030 105030 12/15/2022 Miami Jewish Health Systems, Inc 5200 NE 2nd Avenue Miami, FL 33137

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few The Care plan dated 11/29/22 showed that Resident #293 has the potential/actual nutritional problems related to Chewing/swallowing difficulty and is dependent on eating and drinking. In an interview conducted on 12/14/22 at 5:20 PM with Staff D, Certified Nursing Assistant, was asked if Resident #293 needs help with her meals, Staff D stated, yes, she is a Feeder. When asked by surveyor what that meant, Staff D reported that the resident needed total assistance in the room with all her meals. In an interview conducted on 12/14/22 at 5:30 PM, Resident #293's daughter stated that Staff told her that her mom was not eating at all. She further said that when she comes to see her mom, the Staff say that they will come back to help her with her meals, but they never return to the room. In an interview with the facility ' s Administrator on 12/15/22 at 11:20 AM, he was told of the findings. Class III 105030 Page 2 of 4 105030 12/15/2022 Miami Jewish Health Systems, Inc 5200 NE 2nd Avenue Miami, FL 33137

F 0808 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure therapeutic diets are prescribed by the attending physician and may be delegated to a registered or licensed dietitian, to the extent allowed by State law. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to provide the correct food consistencies for the ordered Pureed diets during dining observations and the second tour of the main kitchen. This has the potential to affect 52 residents residing in the facility on a Pureed diet. The findings included: A review of the Nation Dysphagia Diet Pureed Nutrition Therapy dated September 24, 2019, which Staff E, Registered Dietitian provided, showed the following: Pureed diet is indicated for the resident who has difficulty chewing or swallowing food items and benefits from stricter modifications of food textures to provide foods that can be successfully and safely swallowed. This diet consists of foods that are easy to swallow because they are pureed, smooth, and lump-free, not firm or sticky_ Foods do not require any chewing and may be prescribed due to several medical conditions. In an observation conducted on 12/12/22 at 1:00 PM, Resident #751 was noted in her room with her lunch tray. Closer observation showed the following: a lunch plate of pureed white rice, pureed red cabbage, and 2-inch pieces of beef stew cubes that did not have the same consistency as the pureed rice or the pureed red cabbage. Continued observation showed Resident #751 struggled to cut through the cubed beef stew. (Photographic evidence obtained). A chart review showed that Resident #751 was admitted on [DATE] with a diet order of No Added Salt Pureed texture diet, which was dated 12/12/22. In an observation conducted on 12/14/22 at 11:25 AM, during the lunch meal tray line, two plates of Pureed diet were observed with the following: pureed yellow squash, pureed white rice, and a sizeable, molded piece of seared tilapia (fish) that did not have the same consistency as the white rice or the yellow squash. (Photographic evidence obtained). In this observation, Staff A, Execute Chef, and Staff E, a Registered Dietitian, in the presence of two state surveyors, were asked to take a spoon and cut through the consistency of yellow squash, white rice, and tilapia. Continued observation showed that Staff A could smoothly cut through the white rice and the yellow squash. When attempting to cut through the tilapia, he used more force to cut through, and the consistency of the tilapia was observed with small lumpy pieces. Staff E was then asked to try and cut through the tilapia, yellow squash, and white rice. She acknowledged that more force was used to cut through the fish than the yellow squash or the white rice. Staff E also stated that while cutting the foods, the feeling of consistency was different between the yellow squash and the white rice in comparison to the tilapia. (Photographic evidence obtained). In an interview conducted on 12/14/22 at 11:40 AM with Staff A, the Executive Chef stated that he pureed the tilapia using a blender and used a thickener to mold the fish into the shape that was observed. He then used round tubes to shape them into a firmer shape, so they have a nice appearance on the plate. In an interview conducted on 12/14/22 at 12:07 PM with Staff B and Staff C, Speech Language Pathologists, they stated that pureed diet is completely blended with no chewing involved. When asked if there are several pureed diet levels, they said no. They further stated that they had yet to observe 105030 Page 3 of 4 105030 12/15/2022 Miami Jewish Health Systems, Inc 5200 NE 2nd Avenue Miami, FL 33137

F 0808 Level of Harm - Minimal harm or potential for actual harm the cooking process in the kitchen for the pureed diet consistencies. According to Staff B and Staff C, the pureed diet should not have lumps or pieces. In an interview conducted on 12/14/22 at 12:20 PM Staff E, Registered Dietitian, acknowledged all findings. She further stated that 52 residents in the facility are on a pureed diet. Residents Affected - Few 105030 Page 4 of 4