Health inspection·August 7, 2023

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, record review, and review of the facility's policy, the facility failed to provide appropriate and timely assistance for one (Resident #5) of five residents reviewed for activities of daily living (ADLs), who required extensive assistance with toileting. Residents Affected - Few The findings include: A review of Resident #5's medical record revealed he was admitted to the facility on [DATE] with diagnoses including Parkinson's disease, dementia, personal history of TIA (Transient ischemic attack) and cerebral infarction, mood disorder due to known physiological condition, muscle weakness and anxiety disorder. A review of the admissions minimum data set (MDS) assessment, dated 7/12/23, revealed a brief interview for metal status (BIMS) score of 3 out of a possible 15, indicating severely impaired cognition. Resident #5 required total dependence with transfers, locomotion on/off unit and personal hygiene, extensive assistance with bed mobility, eating and toilet use. He was frequently incontinent of bladder and always incontinent of bowel. During a tour of the facility on 8/7/23 at 11:23 am, Resident #5 was observed sitting in a Broda positioning wheelchair in an open area in the center of the unit used for resident activities and dining. The residents pants were visibly soaked, and a puddle of liquid (light gold in color) was observed underneath his wheelchair. (Photographic evidence obtained) On 8/7/23 at 12:18 pm, Employee G, a certified nursing assistant (CNA) was observed standing over Resident #5 in the dining area, cutting his food on a plate. She suddenly stopped cutting the food and walked away from him. As she left, Resident #5 began feeding himself. Shortly thereafter, Employee G went back to where Resident #5 was seated. As she approached him, she stopped to avoid the puddle of liquid (light gold in color) which remained on the floor. She redirected her path to Resident #5 and approached him from the other side of the table. During this time seven other staff members were observed in the room, including the Assistant Director of Nursing who was providing feeding assistance to another resident. On 8/7/23 at 12:20 pm, Employee H, a personal care attendant (PCA) was told about the puddle of liquid on the floor. He immediately notified Employee G who was seated at the table with Resident #5 providing feeding assistance. He also signaled her that the residents paints were wet. She responded, I know, I'll get it. On 8/7/23 at 12:49 pm, Resident #5 was observed seated in the same area as he had upon the initial Page 1 of 3 105135 105135 08/07/2023 Riverwood Center 2802 Parental Home Road Jacksonville, FL 32216

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few observation. His pants remained soaked, and the colored liquid remained beneath his chair. At this time a CNA was observed walking by Resident #5. See observed the liquid (light gold in color) but did not address the resident's condition or the liquid on the floor. On 8/7/23 at 12:51 pm, while exiting the area where Resident #5 was sitting, six staff members were observed in the area. The resident remained seated in the Broda positioning wheelchair with his pants visibly soaked with liquid. The puddle of liquid (light gold in color) remained on the floor under his chair. (Photographic evidence obtained) During an interview on 8/7/23 at 2:56 pm with Employee CNA G, she stated she had been employed at the facility for a year and a half and had received training on Abuse and Neglect, Resident Rights, and Activities of Daily Living (ADL) care. When asked how she identified neglect or not meeting the residents ADL needs, she said, Not taking care of the resident. When asked how she ensures resident needs are met, she said, Go back and clean them up and make sure they're at the standard you want them to be, clean their nails, brush their teeth and their hair and check and change them. She was familiar with Resident #5 and confirmed she knew he was wet. She explained that she could not do the check and change while she was in the process of feeding him. When asked why she did not change the resident after she finished feeding him, she replied, I was still feeding another resident at that time. We can't stop with the feeding because it's cross contamination. When asked if anyone else was available to change the resident, she replied, Someone could have changed him, but everyone was feeding the residents at the time. When asked if she felt Resident #5 was neglected/ADLs not met, she replied, It was kind of like neglect but what was we supposed to do. I thought we couldn't do that if we were feeding residents because of the cross contamination. During an interview on 8/7/23 at 3:13pm with Employee PCA H, he stated he had been employed at the facility for two months. He stated he received training on Abuse and Neglect, Resident Rights, and Activities of Daily Living (ADL) care. When asked about his observation and response to the incident involving Resident #5, he stated that once he was alerted to the puddle of liquid, he got a wet floor sign, relayed the message to his charge nurse, and tried to find facility maintenance. He confirmed Resident #5's CNA was Employee G and acknowledged he observed the resident's pants were wet. He explained that he was advised staff are supposed to leave the floor with the resident and change them at that time and someone else would take over the feeding. He stated as a PCA he is not allowed to provide feeding assistance nor is he able to remove the resident from the floor to provide toileting assistance. During an interview on 8/7/23 at 3:37 pm with the Director of Nursing, she stated the expectation is to take the person out and to change them. She said, Under the old company they would say it was cross contamination if you would stop feeding the person to go change them. I've in-serviced them and have education going on for the 3-11 pm people. It was the old company's policy, but we haven't been under them for more than a year. I told them they need to get used to doing it this way. She confirmed Employee G had been employed with the facility for a year and a half. A review of the facility's Policy and Procedure for Activities of Daily Living (ADLs), revised on March 2018, revealed: Residents who are unable to carry out their activities of daily living independently will receive the services necessary to maintain good nutrition, grooming, and personal and oral hygiene. Policy Interpretation and Implementation 105135 Page 2 of 3 105135 08/07/2023 Riverwood Center 2802 Parental Home Road Jacksonville, FL 32216

F 0677 Level of Harm - Minimal harm or potential for actual harm 2. Appropriate care and services will be provided for residents who are unable to carry out ADLs independently, with the consent of the resident and in accordance with the plan of care, including appropriate support and assistance with: c. elimination (toileting) Residents Affected - Few (Photographic evidence obtained) . 105135 Page 3 of 3