Health inspection·August 25, 2022

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to ensure that one (Resident #109) of two residents receiving oxygen therapy, from a total of 47 residents in the sample, was administered oxygen at the flow rate ordered by the physician. Residents Affected - Few The findings include: On 8/22/2022 at 11:02 am, Resident #109 was observed lying in bed with his covers pulled to his chest and was receiving oxygen via nasal cannula. He complained that he was not receiving enough oxygen. The resident stated he should receive 3 liters per minute (L/min). The oxygen concentrator located at bedside was observed to be set at 1.5 L/min. (Photographic evidence obtained) A review of Resident #109's physician's order, dated 4/07/2022, revealed he was to receive oxygen at 2 L/min continuously every shift. On 8/23/2022 at 11:58 am, another observation of Resident #109's oxygen concentrator revealed it was set at 1.5 L/min. (Photographic evidence obtained) A medical record review revealed the resident was admitted into the facility on 4/06/2022. His diagnoses included chronic respiratory failure, unspecified whether with hypoxia or hypercapnia; other specified disorders of kidney and ureter; and heart failure, unspecified. A review of the August 2022 Medication Administration Record (MAR) revealed an order for oxygen at 2 L/min via nasal cannula continuously, with nursing initials indicating the oxygen had been provided per the order. (Photographic evidence obtained) Resident #109's vital signs revealed oxygen saturations for August 2022 ranging between 96 to 98 percent for both room air and oxygen via nasal cannula. A review of the quarterly minimum data set (MDS) assessment, dated 7/11/2022, revealed Resident #109 had a Brief Interview for Mental Status (BIMS) score of 8 out of a possible 15 points, indicating moderately impaired cognition. The assessment also documented that he was receiving oxygen therapy. A review of the active care plan, dated 4/11/2022, revealed he was at risk for respiratory complications related to obesity, history of respiratory issues, and continuous oxygen via nasal cannula. Interventions included: check oxygen saturation levels as needed, and oxygen as ordered via nasal canula at 2 L/min. A review of Resident #109's vital signs for August 2022, revealed oxygen saturations ranging between 96 to 98 percent for both room air and oxygen via nasal cannula. Page 1 of 2 105052 105052 08/25/2022 Seaside Health and Rehabilitation Center 324 Wilder Blvd Daytona Beach, FL 32114

F 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few A review of the medication administration note dated 8/6/2022 at 1:41am, revealed oxygen 2 L/min continuously every shift. Resident using oxygen only when he wants. On 08/25/2022 at 10:00 am, accompanied by Licensed Practical Nurse (LPN) A, observed the oxygen concentrator for Resident #109 set to administer oxygen at 1.5 L/min (Photographic evidence obtained). LPN A confirmed that Resident #109's physician's order was for oxygen at a flow rate of 2 L/min. She stated the resident's oxygen saturation was between 96 to 97 percent and he had no distress. Changes in Resident #109's condition regarding his respiratory care was communicated to the Director of Nursing (DON) and his physician. Correct oxygen settings were communicated from one staff person to another by reviewing the medication administration record and through shift reports. On 08/25/2022 at 11:38 am, the DON confirmed that the correct oxygen settings were identified in the MAR and reviewed on the shift-to-shift report. She stated, We have some residents that play with them. Staff respond by educating the residents on their oxygen therapy. It is the nurse's responsibility to ensure that oxygen therapy is provided as ordered. A review of the facility's policy and procedure for Oxygen Administration (undated), revealed procedures for preparation included: Verify that there is a physician's order for this procedure. Review the physician's orders or facility protocol for oxygen administration. . 105052 Page 2 of 2