Health inspection·August 31, 2023

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. Based on observations, record reviews, and interviews, the facility failed to treat with respect and dignity two out of two residents (Residents #68 and #79) who was observed during dining, as evidenced by failure to staff member standing while feeding the resident. This deficient practice had a potential to affect the health and wellbeing of all 28 residents who were dependent with eating. Findings included: Observation on 08/29/23 at 12:33 PM revealed Staff F, Certified Nursing Assistant (CNA), was feeding Resident #68 while she was standing over the resident. On 08/29/23 at 12:33 PM, when asked why she was standing up assisting the residents with dining, Staff F stated that Resident #68 and Resident #79 were feeders. On 08/29/23 at 12:43 PM, observed Staff F was feeding Resident #79 while she was standing over the resident. On 08/31/23 at 11:59 AM, interview with Staff F regarding assisting residents with eating, Staff F stated, For the ones who can't feed themselves, I have to sit them in sitting position, so they can digest the food properly. You will take a seat per say. I don't sit all the time. I wash my hands before and after feeding. Review of the facility's Assistance with Meals policy and procedure Revised March 2022 revealed: Policy statement: Residents shall receive assistance with meals in a manner that meets the individual needs of each resident. Policy Interpretation and Implementation: Residents requiring full assistance: 1. Nursing staff will remove food trays from the food cart and deliver the trays to each resident's room. 2. Residents who cannot feed themselves will be fed with attention to safety, comfort and dignity, for example: a. Not standing over the residents while assisting them with meals; Page 1 of 25 105217 105217 08/31/2023 North Beach Healthcare and Rehabilitation Center 2201 NE 170th Street North Miami Beach, FL 33160

F 0550 b. Keep interactions with other staff to a minimum while assisting residents with meals; Level of Harm - Minimal harm or potential for actual harm c. Avoiding the use of labels when referring to residents (e.g , feeders). Residents Affected - Few 105217 Page 2 of 25 105217 08/31/2023 North Beach Healthcare and Rehabilitation Center 2201 NE 170th Street North Miami Beach, FL 33160

F 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 4. Observation on 08/28/23 at 08:42 AM revealed, Resident #15 was lying in bed watching television, the call light out of reach of resident. Residents Affected - Few On 08/31/23 at 11:26 AM Staff C, (CNA) stated that she has been working in the facility for over three years and her daily shift is five days a week from 7:00 AM to 3:30 PM. Usually she takes care of 8 to 10 residents a day. When she provides care to the resident every day, after she finishes, she is supposed to make sure that the resident is comfortable, and the resident has the call light within reach to be able to use it in case of any emergency. Record review of the Policy and Procedures for Answering the Call Light revised in September 2022 revealed, Purpose: The purpose of this procedure is to ensure timely responses to the resident's requests and needs. General Guidelines: 5-Ensure that the call light is accessible to the resident when in bed, from the toilet, from the shower or bathing facility and from the floor. 5. Observation on 08/31/23 at 08:51 AM showed Resident #392 was in bed eating breakfast and observed all the lights were on in room [ROOM NUMBER]A. On 08/31/23 at 08:51 AM, Resident #392 was interviewed about the care and services received. Resident #392 stated, They don't come here. They don't fix nothing. The light stays on all night. I told them it's not working, but they don't come to fix it. I told the nurses. I don't know their names. I told different ones; all the ones who come to my room. They said they will fix it, but they never come. Interview with the with the maintenance director on 08/31/23 at 12:13 PM, he stated, I am not sure if there was an order for the light, but I can check. We have a system, when the staff go to a room and notice something wrong or the residents tell them something is wrong, they're supposed to enter it into the system. I don't have a work order for the light. When somebody tells us there's a problem, we open a work order for it, we fix it, and we close it out. Review of the facility's Maintenance Service Policy and Procedures dated December 2009 included: Policy statement: Maintenance service shall be provided to all areas of the building, grounds, and equipment. 1. The maintenance department is responsible for maintaining the buildings, grounds, and equipment in a safe and operable manner at all times. 2. Functions of maintenance personnel include, but are not limited to: a. Maintaining the building in compliance with current federal, state, and local laws, regulations, and guidelines. b. Maintaining the building in good repair and free from hazard. e. Maintaining lighting levels that are comfortable, and assuring that exit lights are in good working order. 105217 Page 3 of 25 105217 08/31/2023 North Beach Healthcare and Rehabilitation Center 2201 NE 170th Street North Miami Beach, FL 33160

F 0558 f. Establishing priorities in providing repair services. Level of Harm - Minimal harm or potential for actual harm i. Providing routinely scheduled maintenance service to all areas. Residents Affected - Few 3. The maintenance director is responsible for developing and maintaining a schedule of maintenance service to assure that the building, grounds, and equipment are maintained in a safe and operable manner. Based on observation, interview and record review, the facility failed to ensure reasonable accommodations of residents' need for 5 (Residents #15, #48, #59, #63 & #392) out of 6 sampled residents, as evidenced by call lights were not within reach for the residents and a residents room light did not turn off. This facility's deficient practice had the potential to affect any of the 95 residents residing in the facility at the time of the survey. The findings included: 1. Observation on 08/28/23 at 08:57 AM revealed, resident # 63 was observed sleeping. The call light was seen wrapped around the right bed rail, pointing down to the floor. No distress or anxiety was noted in the resident. (Photographic evidence). Observation on 08/29/2023 at 10:12 AM revealed, resident # 63 was lying on his bed, awake. No distress or anxiety was noted in the resident. It was observed that the call light was found on the floor. (Photographic evidence). Observation on 08/31/2023 at 08:17 AM revealed, resident # 63 was sleeping. The call light was observed wrapped around the right bed rail, pointing down to the floor. (Photographic evidence). 2. Observation on 08/28/2023 at 09:03 AM revealed, resident # 48 was lying on her bed watching television. The call light was observed wrapped around the left bed rail and out of reach for the resident. No distress or anxiety was noted in the resident. (Photographic evidence). Observation on 08/29/2023 at 10:13 AM revealed, resident # 48 was sleeping in bed. The call light was observed wrapped around the left bed rail and out of reach for the the resident. (Photographic evidence). Observation on 08/31/2023 at 08:16 AM revealed, resident #48 was lying on her bed. The call light was observed wrapped around the left bed rail and out of resident's reach. (Photographic evidence). 3. Observation on 08/28/2023 at 08:59 AM revealed, resident # 59 was lying on her bed, awake. The resident was talking to an imaginary person. The call light was observed wrapped around the left bed rail, pointing down to the floor. (Photographic evidence). Observation on 08/29/2023 at 10:10 AM revealed, resident # 59 was lying on her bed. The call light was observed within reach of the resident. (Photographic evidence). Observation on 08/31/2023 at 10:35 AM revealed, resident # 59 was sleeping in bed. The call light was observed on the floor. (Photographic evidence). 105217 Page 4 of 25 105217 08/31/2023 North Beach Healthcare and Rehabilitation Center 2201 NE 170th Street North Miami Beach, FL 33160

F 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview with Staff D, Certified Nursing Assistant (CNA) on 08/31/23 at 10:23 AM. She stated, the call light should be within the resident's reach. She stated, if the resident had a dominant side the call light should be on the side the resident was able to call for assistance. She stated, she didn't know what happened with the resident # 63 because she did rounds on this resident to check on him and the call light was within reach. Interview with Staff E, Certified Nursing Assistant (CNA) on 08/31/23 at 10:32 AM. She stated, the call light must be placed where its reachable for the resident. She stated, when she provided care to the resident at the end, before she leaves the room, she made sure the call light was in the right place. Interview with Staff F, Certified Nursing Assistant (CNA) on 08/31/23 at 10:36 AM. She stated, the protocol for the call light to be placed within resident reach. She stated, if the resident had a non-dominant side, the call light had to be placed at the other side. She stated, when she provided care to resident #59 the call light was within reach. Se stated she doesn't know what happened when the call light was on the floor and maybe the resident had thrown it out of the bed. Interview with the Director of Nursing (DON) on 08/31/2023 at 11:05 AM, the DON stated, the nursing staff had in-service education about the call light should be reachable by the residents, if they need call for assistance, and to answer the call light as soon as possible. 105217 Page 5 of 25 105217 08/31/2023 North Beach Healthcare and Rehabilitation Center 2201 NE 170th Street North Miami Beach, FL 33160

F 0645 PASARR screening for Mental disorders or Intellectual Disabilities Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interview, and record review, the facility failed to ensure the Preadmission Screening and Resident Review (PASARR) Level I for mental illness (MD) or intellectual disability (ID) was completed at the time of admission for resident one (Resident # 59) out of one residents investigated for PASARR. This deficiency had the potential to affect 95 residents residing in the facility at the time of the survey. Residents Affected - Few The findings included: Observation on 08/28/2023 at 08:59 AM revealed, resident # 59 was lying on her bed, awake. The resident was talking and nobody was in the room. No distress or anxiety was noted with the resident. Observation on 08/29/2023 at 10:10 AM revealed, resident # 59 was lying in her bed, awake. No distress or anxiety was noted wit the resident. Observation on 08/31/2023 at 10:35 AM revealed, resident # 59 was sleeping in bed. No distress or anxiety was noted with the resident. Record review of the clinical records for Resident #1 revealed, the resident was admitted to the facility on [DATE] and readmitted on [DATE]. Clinical diagnoses included, but were not limited to, Unspecified Atrial Fibrillation; Unspecified Dementia with Behavioral Disturbance; Major Depressive Disorder, Recurrent, Unspecified; Altered Mental Status, Unspecified; Unspecified Psychosis Not Due to a Substance or Known Physiological Condition. Record review of PASARR Level I dated 09/03/2021 revealed, no identification of any mental diagnosis under 1A. Section 1B was not checked for Serious Mental Illness (SMI). Section 2, 3 (A/B) and 4 (A/B) were checked, No. Record review of admission Minimum Data Set (MDS) Section A Identification Information dated 09/10/2021 revealed, section A1500 - Is the resident currently considered by the state level II PASARR process to have serious mental illness and/or intellectual disability or a related condition? The answer was documented as - No. Record review of Physician Orders dated 09/04/2021 revealed, the resident was receiving Fluoxetine HCL (Hydrochloride) Capsule 10 milligrams, Give 1 capsule by mouth one time a day related to Major Depressive Disorder, Recurrent, Unspecified. Record review of Medication Administration Record (MAR) for the month of August 2023 revealed, the resident was receiving Fluoxetine HCL Capsule 10 milligrams. Give 1 capsule by mouth one time a day related to Major Depressive Disorder, Recurrent, Unspecified as ordered. Record review of Quarterly MDS Section C, Cognitive Patterns dated 12/04/2021 revealed, the resident's Brief Interview for Mental Status (BIMS) summary score was 00 out of 15, indicating severe cognitive impairment. Section I Active Diagnoses dated 12/04/202 revealed, the resident's diagnoses were depression and psychosis disorder. Section N, Medications dated 12/04/2021 revealed, the resident was receiving antidepressants and antipsychotic medications seven days a week. 105217 Page 6 of 25 105217 08/31/2023 North Beach Healthcare and Rehabilitation Center 2201 NE 170th Street North Miami Beach, FL 33160

F 0645 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Record review of Care Plan initiated on 9/4/2021 with the next review date 9/5/2023 revealed care plans for, The resident had the potential for adverse side effects related to the use of psychotropic medications: antidepressant for depression, sleep aid for insomnia. Goal: Resident will remain free from adverse side effects related to use of psychotropic medications through the next review date. · Resident will receive the lowest effective dose of psychotropic medication to ensure maximum functional ability through the next review date. Interventions: Administer psychotropic medications as ordered. Observe for effectiveness of psychotropic medications. Observe for adverse side effects related to psychotropic med use; report to physician if noted. Educate resident/family on potential risk/benefits of psychotropic medication use. Laboratories as ordered, report findings to physician. Abnormal Involuntary Movement Scale (AIMS) assessment as indicated. Psychotropic review for dose reduction as able Psychiatry Services or Psychological Services as ordered. Observe for changes in mood/behavior; report to physician if noted. Interview with Staff A, Licensed Practical Nurse (LPN) on 08/31/23 at 08:35 AM revealed, she stated the resident was not aggressive, but confused. The Resident was alert but not oriented. She stated, the resident is very quiet and pleasant with the staff and other residents. She was not able to request assistance. The resident's family was very involved in the resident's care; the resident was assisted by the Certified Nursing Assistant with some tasks that she can't do it by herself. Her appetite is good, and the resident tolerated medication with no problem. Interview with Social Services Director on 08/31/23 at 09:07 AM revealed, she stated, she reviewed the hospital discharge and reviewed the Level I PASARR. She stated, she didn't review this residents Level I PASARR, because the resident was admitted in 2021. She stated she will correct the Level I PASRR with diagnosis and resubmit it again. Interview with the Social Services Director on 08/31/23 at 11:29 AM revealed, she stated, the Level I PASARR was submitted for resident # 59. Record review of the Policies and Procedures for admission Criteria revised in March 2019 revealed, Policy Statement: Our facility admits only residents whose medical and nursing care needs can be met. Policy Interpretation and Implementation: 9- All new admissions and readmissions are screened for mental disorders (MD), intellectual disabilities (ID) or related disorders (RD) per the Medicaid Pre-admission Screening and Resident Review (PASRR) process. a- The facility conducts a Level I PASRR screen for all potential admissions, regardless of payer source, to determine if the individual meets the criteria for a MD, ID, or RD. 105217 Page 7 of 25 105217 08/31/2023 North Beach Healthcare and Rehabilitation Center 2201 NE 170th Street North Miami Beach, FL 33160

F 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to develop a smoking and oxygen care plan for resident # 12 and #192 out of 14 sampled residents reviewed at the time of the survey for oxygen and smoking. The findings included: 1. Resident #12 record review on Smoking revealed, the resident was admitted to the facility on [DATE]. Record review of the resident's diagnoses included, but were not limited to, Osteomyelitis, Unspecified, Type 2 Diabetes Mellitus with Unspecified Complication, Acute Respiratory Failure With Hypoxia, Peripheral Vascular Disease, Unspecified, Mood (Effective) disorder, Hypothyroidism, Unspecified, Sepsis, Unspecified Organism, Bipolar disorder, Anemia in other Chronic disease Classified Elsewhere. Record review of the residents care plans revealed, the facility did not develop a smoking Care Plan for the resident. Record review of the admission Minimum Data Set (MDS) dated [DATE] revealed, the resident Brief Interview for Mental Status (BIMS) score was a 15 out of 15, indicating the resident was cognitively intact and that he is a tobacco user. Interview with the Director of nursing (DON) on 08/30/23 at12:03 PM revealed, the assessment was done but the care plan was missing. Interview with the MDS Coordinator on 08/30/23 at 12:09 PM it was revealed, there should be a smoking care plan for the resident, and there wasn't one and this was an oversight. The MDS Coordinator reported, usually when the resident is admitted she checks the assessment and does the care plan. On 08/30/23 at12:45 PM after the interview with the MDS coordinator, she provided a hand written copy of a care plan and she stated; I forgot that I did this at the time of admission but I forgot to put it in the system. Record review of the Smoking Policy - Residents revealed, the Effective date of 09/15/2022, that included: The center will establish and maintain a safe designated smoking area and safe smoking practices for the residents. Smoking is only allowed in the designated area of the facility and during designated times. Smoking is not allowed during inclement weather. Oxygen is not permitted within 50 feet from the designated smoking area. The center will have safety equipment available in the designated smoking areas including: a fire blanket, smoking apron, a fire extinguisher, and non-combustible self-closing ashtray. Procedures: 2. If resident is identified during the smoking assessment by the interdisciplinary team to require 105217 Page 8 of 25 105217 08/31/2023 North Beach Healthcare and Rehabilitation Center 2201 NE 170th Street North Miami Beach, FL 33160

F 0655 assistance, supervision with smoking, the Center will include the appropriate information in the care plan. Level of Harm - Minimal harm or potential for actual harm 2. Resident #192 record review for Oxygen revealed, the resident was admitted to the facility on [DATE]. Residents Affected - Few Record review revealed, the resident's diagnoses included, but were not limited to, Acute on Chronic Diastolic Congestive Heart Failure, Atherosclerosis Heart Disease of Native Coronary Artery without Angina Pectoris, Malignant Neoplasm of Pancreas, Type 2 Diabetes Mellitus with other specified Complications, Type 2 Diabetes Mellitus with Diabetic Peripheral Angiopathy Without Gangrene, Dependence on Renal Dialysis, Shortness of breath, Record review of the care plans revealed, the facility did not develop an Oxygen Care Plan for the resident. Record review of the admission MDS dated [DATE] revealed, the residents BIMS score was 15 out of 15 indicating the resident was cognitively intact and that the rest of MDS was in progress. Interview with Staff A, Licensed Practical Nurse (LPN) on 08/30/23 at 08:54 AM revealed that she has been working in the facility for over a year. Staff A reported, I have not been working since last Thursday, today is my first day back. The Oxygen that resident has now, was put by the night shift nurse. I have not given the medication yet. During an interview with the Director of Nursing (DON) on 08/30/23 at 9:00 AM it was reported, she did not know why the resident was receiving Oxygen and that maybe the orders came from the hospital where she was admitted , and they forgot to put it in the system. Interview with the MDS Coordinator on 08/30/23 at 12:13 PM revealed, the assessment was not completed but, at least the base line care plan should've been completed. Interview with Staff B, LPN, on 08/31/23 at 11:50 AM revealed, she has been working in the facility since February of this year 2023 and she works three days a week, 12 hours shift. Staff B reported, if she sees a new resident using oxygen, she will go to PCC (Point Click Care) to verify if there is an order and to make sure the resident has the accurate amount of oxygen liters set. We are supposed to check the oxygen every shift. If there is no order, I will stop the oxygen immediately and I will call the doctor to see if resident needs the order and if the doctor can provide me the order by phone. Record review for the Policies and procedures for Medication and Treatment dated Revised July 2016 included: Medication and Treatments Orders: Policy Statement: Orders for medications and treatments will be consistent with principles of safe and effective order writing. Policy Interpretation and Implementation 105217 Page 9 of 25 105217 08/31/2023 North Beach Healthcare and Rehabilitation Center 2201 NE 170th Street North Miami Beach, FL 33160

F 0655 Level of Harm - Minimal harm or potential for actual harm 1. Medication shall be administered only upon the written order of person duly licensed and authorized to prescribe such medication in this state. 2. Only authorized, licensed practitioner, or individuals authorized to take verbal orders from practitioners, shall be allowed to write orders in medical records. Residents Affected - Few 4. All Drugs and biological orders shall be written, dated, and signed by the person lawfully authorized to give such an order. 5. The signing of orders shall be by signature or a personal computer key. Signature stamps may not be used. 7. Verbal orders must be recorded immediately in the resident's chart by the person receiving the order and must include prescriber's last name, credentials, the date and the time of the order. 9. Orders for medications must include: a. Name and strength of the drug; b. Number of dose, start and stop date, and/or specific duration of therapy; c. Dosage and frequency of administration; d. Route of administration; e. Clinical condition or symptoms for which the medication is prescribed; and f. Any interim follow-up requirements (pending culture and sensitivity reports, repeat labs, Therapeutic medication monitoring, etc.) Record review for the policy and procedure for Oxygen Administration dated Revised October 2010 included: Purpose: The purpose of this procedure is to provide guidelines for safe oxygen administration. Preparation: 1. Verify that there is a Physician's order for this procedure. Review the physician's orders or facility protocol for oxygen administration. 2. Review the resident's care plan to assess for any special needs of the resident. 3. Assemble the equipment and supplies as needed. Record review for the policy and procedure for Care Plan, Comprehensive Person-Centered dated Revised on March 2022 included: 105217 Page 10 of 25 105217 08/31/2023 North Beach Healthcare and Rehabilitation Center 2201 NE 170th Street North Miami Beach, FL 33160

F 0655 Policy Statement: Level of Harm - Minimal harm or potential for actual harm A comprehensive, person-centered care plan that includes measurable objectives and timetable to meet the resident's physical, psychosocial and functional needs is developed and implemented for each resident. Residents Affected - Few Policy Interpretation and Implementation: 1. The interdisciplinary team (IDT), in conjunction with the resident and his/her family or legal representative, develops and implements a comprehensive, person-centered care plan for each resident. 2. The comprehensive, person-centered care plan is developed within seven (7) days of the completion of the required MDS assessment (Admission, Annual or Significant Change in Status), and no more than 21 days after admission. 105217 Page 11 of 25 105217 08/31/2023 North Beach Healthcare and Rehabilitation Center 2201 NE 170th Street North Miami Beach, FL 33160

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 4. Resident #192 record review for Oxygen revealed, the resident was admitted to the facility on [DATE]. Residents Affected - Some Record review revealed, the resident's diagnoses included, but were not limited to, Acute on Chronic Diastolic Congestive Heart Failure, Atherosclerosis Heart Disease of Native Coronary Artery without Angina Pectoris, Malignant Neoplasm of Pancreas, Type 2 Diabetes Mellitus with other specified Complications, Type 2 Diabetes Mellitus with Diabetic Peripheral Angiopathy Without Gangrene, Dependence on Renal Dialysis, Shortness of breath, Record review of the care plans revealed, the facility did not develop an Oxygen Care Plan for the resident. Record review of the admission MDS dated [DATE] revealed, the residents BIMS score was 15 out of 15 indicating the resident was cognitively intact and that the rest of MDS was in progress. Interview with Staff A, Licensed Practical Nurse (LPN) on 08/30/23 at 08:54 AM revealed that she has been working in the facility for over a year. Staff A reported, I have not been working since last Thursday, today is my first day back. The Oxygen that resident has now, was put by the night shift nurse. I have not given the medication yet. During an interview with the Director of Nursing (DON) on 08/30/23 at 9:00 AM it was reported, she did not know why the resident was receiving Oxygen and that maybe the orders came from the hospital where she was admitted , and they forgot to put it in the system. Interview with the MDS Coordinator on 08/30/23 at 12:13 PM revealed, the assessment was not completed but, at least the base line care plan should've been completed. Interview with Staff B, LPN, on 08/31/23 at 11:50 AM revealed, she has been working in the facility since February of this year 2023 and she works three days a week, 12 hours shift. Staff B reported, if she sees a new resident using oxygen, she will go to PCC (Point Click Care) to verify if there is an order and to make sure the resident has the accurate amount of oxygen liters set. We are supposed to check the oxygen every shift. If there is no order, I will stop the oxygen immediately and I will call the doctor to see if resident needs the order and if the doctor can provide me the order by phone. 5. Observation of Resident # 242 on 08/28/2023 at 8:43 AM revealed, the resident was sleeping in bed and the resident had a oxygen via nasal cannula at 2 Liters Per Minute (LPM), with an oxygen concentrator at the bedside. Observation of Resident # 242 on 08/29/2023 at 10:11 AM revealed, the resident was lying in his bed with his eye open. The Resident was nonverbal. The resident was observed with oxygen via nasal cannula at 2 LPM. Observation of Resident # 242 on 08/30/2023 at 08:48 AM revealed, the resident was sleeping in bed. The resident was observed with oxygen via nasal cannula at 2 LPM. Record review of the clinical records for Resident # 242 revealed, the resident was admitted to the 105217 Page 12 of 25 105217 08/31/2023 North Beach Healthcare and Rehabilitation Center 2201 NE 170th Street North Miami Beach, FL 33160

F 0695 Level of Harm - Minimal harm or potential for actual harm facility on [DATE]. Clinical diagnoses included, but were not limited to, Hemiplegia and Hemiparesis following Cerebral Infarction Affecting Left Non-Dominant Side; Respiratory Failure, Unspecified with Hypercapnia; Respiratory Failure, Unspecified with Hypercapnia; Type 2 Diabetes Mellitus Without complications. Residents Affected - Some Record review of physician orders for oxygen revealed, there were no orders for oxygen for resident # 242. Record review of Treatment Administration Record for the month of August 2023 revealed, there were no oxygen treatment for resident # 242. Record review of the admission Minimum Data Set (MDS) Section C, Cognitive Patterns dated 08/12/2023 revealed, the resident Brief Interview for Mental Status (BIMS) summary score was 00 out of 15, indicating severe cognitive impairment. Section O, Special Treatments, Procedures and Programs dated 08/12/2023 revealed, the resident was using oxygen. Record review of Care Plan initiated on 8/10/2023 and the next review date 11/21/2023 revealed a care plan for, The resident had the potential for complications of respiratory distress related to impaired mobility, Accident Cerebrovascular (CVA) with left hemiparesis, End-Stage Renal Disease (ESRD), Anemia, Diabetes Mellitus, Acute Renal Failure (ARF), Hypothyroidism. Goal: Resident will be able to maintain patent airway and will not exhibit any signs/symptoms of respiratory distress. Interventions: Administer medications as ordered; observe for effectiveness and side effects. Administer supplemental oxygen as ordered. Elevate Head of Bed >30 degrees as needed to minimize Shortness of Breath. Observe for signs /symptoms or respiratory infection and/or distress; notify physician as indicated. During an interview with Staff B, Licensed Practical Nurse (LPN) on 08/31/23 at 10:28 AM, she stated, she reviewed the resident when the shift started. She stated, she made rounds to see the residents and the nurse leaving informed her about residents' issues. She stated, resident # 242 had oxygen set up at 2 LPM. She stated, she followed the physician orders. She stated, there was an order for the oxygen. She stated, she realized the orders were written on 08/30/2023 and the resident had oxygen since he was admitted on [DATE]. Interview with Director of Nursing on 08/31/23 at 10:42 AM, she stated the residents usually came with oxygen when they were admitted from the hospital. She stated, the order had to be written immediately when the resident was admitted . She stated, as soon you write the order in the computer it transferred to the treatment record. She stated, the physician order for the resident was written on 08/30/2023 and the resident was admitted since 08/09/2023. Record review for the Policies and procedures for Medication and Treatment dated Revised July 2016 included: Medication and Treatments Orders: Policy Statement: Orders for medications and treatments will be consistent with principles of safe and effective order writing. 105217 Page 13 of 25 105217 08/31/2023 North Beach Healthcare and Rehabilitation Center 2201 NE 170th Street North Miami Beach, FL 33160

F 0695 Policy Interpretation and Implementation Level of Harm - Minimal harm or potential for actual harm 1. Medication shall be administered only upon the written order of person duly licensed and authorized to prescribe such medication in this state. Residents Affected - Some 2. Only authorized, licensed practitioner, or individuals authorized to take verbal orders from practitioners, shall be allowed to write orders in medical records. 4. All Drugs and biological orders shall be written, dated, and signed by the person lawfully authorized to give such an order. 5. The signing of orders shall be by signature or a personal computer key. Signature stamps may not be used. 7. Verbal orders must be recorded immediately in the resident's chart by the person receiving the order and must include prescriber's last name, credentials, the date and the time of the order. 9. Orders for medications must include: a. Name and strength of the drug; b. Number of dose, start and stop date, and/or specific duration of therapy; c. Dosage and frequency of administration; d. Route of administration; e. Clinical condition or symptoms for which the medication is prescribed; and f. Any interim follow-up requirements (pending culture and sensitivity reports, repeat labs, Therapeutic medication monitoring, etc.) Record review for the policy and procedure for Oxygen Administration dated Revised October 2010 included: Purpose: The purpose of this procedure is to provide guidelines for safe oxygen administration. Preparation: 1. Verify that there is a Physician's order for this procedure. Review the physician's orders or facility protocol for oxygen administration. 2. Review the resident's care plan to assess for any special needs of the resident. 3. Assemble the equipment and supplies as needed. Based on observations, record reviews, and interviews, the facility failed to obtain physician's 105217 Page 14 of 25 105217 08/31/2023 North Beach Healthcare and Rehabilitation Center 2201 NE 170th Street North Miami Beach, FL 33160

F 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some order for oxygen therapy for five (#2, #46, #87, #192, and #242) residents out of fourteen residents who were receiving oxygen treatment. The findings included: 1. During observations for resident #2 on 08/28/23 at 09:28 AM, the Resident was seen with oxygen by nasal cannula at 2.5 liters a minute (LPM). Resident #2 stated, I have asthma and I'm able to walk. On 08/29/23 at 11:25 PM, the resident was seen with oxygen via nasal cannula. On 08/29/23 at 03:07 PM, the Resident was resting in bed with eyes closed. On 08/30/23 at 11:17 AM, the resident was observed with oxygen at two liters by nasal cannula. (See photo evidence) Record review revealed a medical diagnosis of Chronic Obstructive Pulmonary Disease. Record review of the residents physician orders revealed, there were no orders for oxygen. Record review for Resident#2 revealed, in Minimum Data Set (MDS), Quarterly dated 5/24/23 revealed, in Section C: Cognitive Patterns, a Brief Interview of Mental Status (BIMS) score was a four meaning severe cognitive impairment. In section G: Functional Status, locomotion on the unit was total dependence by one-person physical assist. In section: J: Health Conditions, no symptoms of shortness of breath. In section O: Special Treatments, Procedures, and Programs - Yes, to Oxygen therapy. Review of the care plans for Resident #2 stated, A potential for complications of respiratory distress related to Chronic Obstructive Pulmonary Disease and a history of Bronchitis. The goal stated Resident #2 will remain free from signs and symptoms of respiratory distress thru the next review. Interventions were oxygen saturations as ordered and administering oxygen as ordered. On 08/30/23 at 01:08 PM, in an interview with Staff J, LPN (Licensed Practical Nurse). When asked, Does Resident #2 have oxygen orders? Staff J, LPN stated, I'm activating the resident's oxygen orders. The education instructor told me to place orders. Record Review of the physician orders for resident #2 revealed, oxygen at two liters per minute via nasal cannula oxygen was placed on 8/30/23 at 1:04 PM. 2. In observations for Resident #46, on 08/28/23 at 09:08 AM, Resident #46 was observed on 3 LPM vis nasal cannula. On 08/29/23 at 10:43 AM, the oxygen concentrator was on at 3 LPM, but the nasal cannula wasn't on the resident. On 08/30/23 at 11:21 AM, the oxygen was at 2LPM via nasal cannula. (See photographic evidence) Record review of of the residents medical diagnoses revealed, nontraumatic intracerebral hemorrhage. Record review of the physician orders revealed, there was no orders for oxygen. Record review for Resident #46 revealed, in the MDS, for a Significant Change dated 8/25/23 revealed, in section C: Cognitive Patterns, the BIMS score was a three meaning the resident had severe cognitive impairment. In G: Functional Status, locomotion on the unit was total dependence. In section J: Health Conditions, shortness of breath or trouble breathing when sitting at rest and flat was a yes. In section O Special Treatments, Procedures, and Programs. Oxygen was not available to answer. 105217 Page 15 of 25 105217 08/31/2023 North Beach Healthcare and Rehabilitation Center 2201 NE 170th Street North Miami Beach, FL 33160

F 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Review of the care plans for Resident #46 revealed, A potential for complications of respiratory distress related to a history of respiratory insufficiency. The goal was Resident #46 will remain free from signs and symptoms of respiratory distress thru the next review. Interventions were to administer medications as ordered, observe for effectiveness and side effects. On 08/30/23 at 01:15 PM, in an interview with Staff J, LPN, when asked, Does Resident #46 have oxygen orders? Staff J stated, Resident #46 is under hospice, and they place orders for the residents. Staff J stated, Orders are placed on an order sheet and uploaded to an electronic health record. Record Review of the physician orders for resident #46 revealed, oxygen at 3 LPM via nasal cannula was placed on 8/30/23 at 2:41 PM. 3. During observations for Resident #87, on 08/28/23 at 08:37 AM, Resident #87 was eating breakfast and had oxygen at 2 LPM via nasal cannula, but the cannula was off. On 08/29/23 at 10:49 AM. Resident #87 was on 2 LPM OF oxygen via nasal cannula. On 08/30/23 at 11:25 AM, Resident #87 was resting in bed with 2 LPM of oxygen via nasal cannula. (See photo evidence) Record review of the medical diagnosis revealed, Chronic Obstructive Pulmonary Disease. Record review of the residents physician orders revealed, there were no orders for oxygen. Record review for Resident #87 revealed, in the MDS admission dated 8/1/23. In section C: Cognitive Patterns, the BIMS score was a 13 meaning the resident was cognitively intact. In section G: Functional Status, Locomotion on the unit was extensive assistance with one-person physical assist. In section J: Health Conditions, shortness of breath or trouble breathing when lying flat was a yes. In section O: Special Treatments, Procedures, and Programs. Oxygen was a Yes. Review of the care plans for Resident #87 revealed, A potential for complications of respiratory distress related to chronic obstructive pulmonary disease. The goal was Resident will be able to maintain a patent airway and will not exhibit any signs and symptoms of respiratory distress. Interventions were to administer medications as ordered, observe for effectiveness and side effects. Elevate head of bed above 30 degrees as needed to minimize shortness of breath. In an interview on 08/30/23 at 01:06 PM, Staff J, LPN, was asked, Does Resident #87 have orders for oxygen? Staff J stated, I will get oxygen orders for the resident. I will call the doctor. Record Review of the physician orders for resident #87 revealed, oxygen at 2 LPM with humidification was placed on 8/30/23 at 11:41 PM. On 08/30/23 at 02:51 PM, during an interview with the Director of Nursing (DON), it was discussed that Residents #87, #46, and #2 did not have orders for oxygen therapy. The DON stated, For Resident #46, his oxygen order is new. Lately, he has been in and out of the hospital. He is a recent hospice admission. Hospice doesn't have access to our electronic health record. 105217 Page 16 of 25 105217 08/31/2023 North Beach Healthcare and Rehabilitation Center 2201 NE 170th Street North Miami Beach, FL 33160

F 0732 Post nurse staffing information every day. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to have daily nurse staffing posted prior to the beginning of shifts on 2 of 2 nurses' stations. This had the potential to affect the 95 residents who resided in those units at the time of this survey. Residents Affected - Few The findings included: During an observation at the South Nurse's station, on 08/28/2023 at 07:48 AM, it was noted that the staffing information posted was dated Sunday, 08/27/2023 but belonged to the 3-11 PM shift, not the 7AM-3PM shift. (Photo Evidence Obtained). During an observation at the North Nurse's station on 08/28/2023 at 07:50 AM, it was noted that the staffing information posted was dated Tuesday, 08/22/2023 and belonged to 7 AM-3PM shift. (Photo Evidence Obtained). Interview with Staff G, Licensed Practical Nurse (LPN) on 08/28/23 at 08:35 AM, it was reported, the protocol is to update the nursing board, to review the schedule and write it on the board. He stated, he made a mistake, he changed the staff on the board, but didn't change the date. Interview with Director of Nursing on 08/28/23 at 08:24 AM revealed, she stated, the protocol to update the nursing board included, the nurse in charge was to update the board following the schedule. She stated, she was aware that the nursing board was not updated in the morning. 105217 Page 17 of 25 105217 08/31/2023 North Beach Healthcare and Rehabilitation Center 2201 NE 170th Street North Miami Beach, FL 33160

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on observation, record review, and interview, the facility failed to ensure the accuracy of narcotic records on two out of four medication carts reviewed. There were 95 residents residing at the facility at the time of the survey. The findings included: On 08/29/23 at 11:29 AM, during an observation on medication cart two on the North Wing with Staff H, LPN (Licensed Practical Nurse). The narcotic book revealed on 8/28/23, there were 14 cards/containers for the day/night shifts. On 8/29/23, the narcotic book revealed the night shift had a count of 14, and the day shift nurse had a count of 13. Staff H, LPN and the Surveyor counted that there were 13 controlled substances on the medication cart. When asked, Where is the 14th medication? Staff H stated, I received 13 narcotic medications. (See photographic evidence.) On 08/29/23 at 02:13 PM, during an observation of medication cart two on the South Wing with Staff I, LPN. An oral solution of Lorazepam 2 mg (milligram) per one ml (milliliters) had 21 ml in its container. The latest dose was given on 8/22/23 at 08:58pm. The amount on hand was 24 ml, the amount given was 1 ml and the amount remaining was 22 ml. Record review of the Lorazepam 2 mg per one ml controlled drug disposition record revealed, the physician order stated to give one ml sublingually every 6 hours as needed for agitation, anxiety, or seizures. On 8/3/23, it stated that 30 ml were in the container. It was documented, on 8/3/23 at 8:15 p.m. 29 ml was on hand, one ml was given with 28 remaining. On the next line it stated, on 8/14/23 at 03:17pm, 0.5 ml was given with 27 ml remaining. It was documented on 8/22/23 at 11:29 am. 25 ml was on hand, one ml was given and 24 ml was remaining. On 8/22/23 at 08:58pm, 24 ml was on hand, one ml was given, and 22 ml was remaining. On 08/29/23 at 02:25 PM during an interview with Staff I, LPN, it was asked, What is the facility's policy for counting and recording narcotics? Staff I, LPN stated, The nurses perform narcotic count checks between shifts. The incoming nurse counts bingo cards and the nurse going off has the book to verify the count. Liquid medications should be placed on a flat surface and go by the level of the liquid. On 08/30/23 at 02:51 PM, during an interview with the Director of Nursing (DON), the DON was shown and the concerns about the narcotic count and narcotic records on medication carts were discussed. The DON stated, For the North Wing cart, the previous sheet stated 13 medications, and on the new sheet the nurse wrote 14. It was a transcribing error. On the South Wing, one nurse gave medications on 8/21/23. The nurse did not record it on the written documentation but it's in the electronic health record. I have a signed a note that the nurse gave one ml and recorded 0.5 ml on the narcotic record. When asked, What is the facility's policy on narcotic counts and narcotic documentation? The DON stated, Nurses are to make sure administration of medication is documented, records are accurate, and no errors should be found in the documentation. That's why we have two nurses to check the count and records. We will immediately do an education and in-services with the nursing staff. Review of facility's policy titled, Controlled Substances dated Revised April 2019 states: The 105217 Page 18 of 25 105217 08/31/2023 North Beach Healthcare and Rehabilitation Center 2201 NE 170th Street North Miami Beach, FL 33160

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few purpose statements stated the facility complies with all laws, regulations, and other requirements related to handling, storage, disposal, and documentation of controlled medications. In the section titled, Policy Interpretation and Implementation. 8) Controlled substances are reconciled upon receipt, administration, disposition, and at the end of each shift. In the section titled, Upon Receipt. A) The nurse receiving the medication and the individual delivering the medication verify the name, dose, and quantity of each controlled substance being delivered. In the section titled, Upon Administration. A) The nurse administering the medication is responsible for recording 2) The name, strength, and dose of medication 5) The quantity of the medication remaining. In the section titled, At the end of each shift, A) Controlled medications are counted at the end of each shift. The nurse coming on duty and the nurse going off duty determine the count together. B) Any discrepancies in the controlled substance count are documented and reported to the Director of Nursing Services immediately. 105217 Page 19 of 25 105217 08/31/2023 North Beach Healthcare and Rehabilitation Center 2201 NE 170th Street North Miami Beach, FL 33160

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and interviews, the facility failed to ensured medications were securely stored as evidenced by one loose medication pill found on the floor of a resident's room and loose pills found on two out of four carts checked. There were 95 residents residing in the facility at the time of the survey. The findings include: On 08/28/23 at 09:15 AM, in room [ROOM NUMBER], an orange pill with the writing G/500 was found on the floor near the door. (See photographic evidence) On 08/28/23 at 09:30 AM, the pill was given to Staff G, LPN (Licensed Practical Nurse). Staff G was asked, This pill was found on the floor, what is it, and did you give medications to the resident yet? Staff G stated, I did not give medications to room [ROOM NUMBER] yet. This medication may be Methocarmolol 500 mg which is given every twelve hours. The last administration time was on the night shift. It was stated that Methocarbamol Tablet 500 MG is a muscle relaxer to treat muscle spasms and pain. On 08/29/23 at 11:29 AM, during an observation of cart two on the North Wing with Staff H, LPN. A white pill with the writing of 2204/ TV was found. Staff H disposed of the medication in a drug buster. On 08/29/23 at 02:13 PM, during an observation and interview of cart 2 on the South Wing with Staff I, LPN, a medication pill with the writing of C/ 128, a broken half-blue pill, and a white pill with the writing of 1/C were found. When asked, What is the facility's policy regarding loose pills found on carts and cleaning medication carts? Staff I stated, When loose pills are found in the cart, we are to put it in the pill destroyer and clean our carts on our shift. On 08/30/23 02:51 PM, during an interview with the Director of Nursing (DON) about, the loose pills found on the medication carts and a medication pill found on the floor. The DON stated, We should not have any loose pills on carts. Nurses are to discard the medication when found. We did an all-cart check this morning. Medication carts are to be kept neat. Review of facility's policy titled, Storage of Medications dated Revised November 2020. The purpose statement states, the facility stores all drugs and biologicals in a safe, secure, and orderly manner. In the section titled, Policy Interpretation and Implementation. 3) The nursing staff is responsible for maintaining medication storage and preparation areas in a clean, safe, and sanitary manner. 105217 Page 20 of 25 105217 08/31/2023 North Beach Healthcare and Rehabilitation Center 2201 NE 170th Street North Miami Beach, FL 33160

F 0867 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. Based on interview and record review, the facility failed to demonstrate effective plan of actions were implemented to correctly identify quality deficiencies in the problem area related to repeated deficient practices for F695 Respiratory/tracheotomy Care and Suctioning and F880 Infection Prevention and Control. This practice has the potential to increase the risk of negative resident outcomes and to affect all 95 residents residing in the facility at the time of this survey. The findings included: Record review of the facility's survey history revealed, during a recertification survey with exit date 08/25/22 Respiratory/Tracheotomy Care and Suctioning and Infection Prevention and Control. During an interview on 08/31/23 at 01:09 PM, the Administrator: They meet monthly with all department Medical Director, Administrator, Director of Nursing, Assistant Director of Nursing, HIA, MDS Coordinator, Central Supply/Staffing, Activities Director, Social Service Director, Rehab Director, Human Resources Director, admission Director, Maintenance Director, Housekeeping Director, Food Service Director, Medical Director. The Administrator stated, We have Performance Improvement Plans (PIPs) for Abuse and Federal Reporting and notification of changes, initially there was weekly audits and now monthly audits. Grievance reviews, any more responses required, and any that has been reported, has been reported. Any significant of change has been notified to the proper parties. Urinary Tract Infection (UTI) and Dehydration, through [NAME] report, because residents being sent to the hospital had had hydration issues. Staff has been educated and a hydration program has been started, the residents have a daily hydration program. In the last month there were no discharges done with hydration issues. UTI's went down from 8 to 4. We go thru everything else in the QAPI process. Review of the Policies and Procedures titled 2023 QAPI Plan included: Policy Statement: The Quality Assurance and Performance Improvement Program is overseen and implemented by the QAPI (Quality Assurance and Performance Improvement) Committee, which reports its findings, actions and results to the Administrator and Governing Body. Quality Assurance and Performance Improvement Program (PIPs): The facility shall develop, implement, and maintain an ongoing, facility-wide, data-driven QAPI Program that is focused on indicators of the outcomes of care and quality of life for our residents. Policy objectives of QAPI Program are to: 1. 105217 Page 21 of 25 105217 08/31/2023 North Beach Healthcare and Rehabilitation Center 2201 NE 170th Street North Miami Beach, FL 33160

F 0867 Provide a means to measure current and potential indicators for outcomes of care and quality of life. Level of Harm - Minimal harm or potential for actual harm 2. Residents Affected - Few Provide a means to establish and implement performance improvement projects to correct identified negative or problematic indicators. 3. Reinforce and build upon effective systems and processes related to delivery of quality care and service. 4. Establish systems through which to monitor and evaluate corrective actions. Implementations: 1. The QAPI Committee oversees implementation of our QAPI Plan, which is the written component describing the specifics of the QAPI program, how the facility will conduct its QAPI functions, and the activities of the QAPI Committee. 2. The QAPI plan describes the process for identifying and correcting quality deficiencies. Key components of this process include: a. Tracking and measuring performance. b. Establishing goals and thresholds for performance measurement. c. Identifying and prioritizing quality deficiencies. d. Systematically analyzing underlying causes of systematic quality deficiencies. e. Developing and implementing corrective action of performance improvement activities; and 105217 Page 22 of 25 105217 08/31/2023 North Beach Healthcare and Rehabilitation Center 2201 NE 170th Street North Miami Beach, FL 33160

F 0867 f. Level of Harm - Minimal harm or potential for actual harm Monitoring or evaluating the effectiveness of corrective action/performance improvement activities and revising as needed. Residents Affected - Few 3. The committee meets monthly to review reports, evaluate data, monitor QAPI-related activities and make adjustments to the plan. 105217 Page 23 of 25 105217 08/31/2023 North Beach Healthcare and Rehabilitation Center 2201 NE 170th Street North Miami Beach, FL 33160

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews, and record review, the facility failed to ensure infection control practices related to hand hygiene was implemented during dining observation. As evidenced by staff failure to sanitize hands while passing resident meal trays. This deficient practice has the potential to cause cross contamination and affect all residents in the facility. There were 95 residents residing in the facility at the time of this survey. Residents Affected - Few The indings included: Observation on 08/28/23 at 12:08 PM Staff F, Certified Nursing Assistant (CNA), brought 3 food trays to room [ROOM NUMBER], then Staff F set up the plates for the residents. Observed Staff F come out of the room, not washing her hands, and picked up some linens on a cart. Observed Staff F left with the linens and came back to the food cart. Observed Staff F without washing her hands grabbed a pot on top of the food cart and poured some juice in a cup. Staff F then took a food tray and left. Staff F did not wash her hands during the whole process. On 08/28/23 at 12:39 PM, observed Staff I, License Practical Nurse (LPN), took a food tray from the cart and took it to room [ROOM NUMBER]; Staff I did not wash her hands. Observed Staff I come back, picked up a food tray and left it in room [ROOM NUMBER]; Staff I did not wash her hands. Observed Staff I come back to the food cart, got some juice and took it to room [ROOM NUMBER], and still not washing her hands. Staff I came to the food cart, picked up a food trays for room [ROOM NUMBER] and did not wash her hands. Staff I came back and took a food tray to room [ROOM NUMBER], then used hand sanitizer. On 08/31/23 at 11:59 AM, during an interview with Staff F, she stated, the procedures is the nurse has to give it (food tray) to me. When I go to the room I have to knock on the door. I have to put the tray on the table and ask them if they like juice, coffee, or water. Then I will tell them enjoy the meals and have a nice day. That's for the ones who can feed themselves. We have hand sanitizer in the rooms and in the hallways. I wash my hands in the room after putting it on the table after each food tray. When my hands become sticky, I go and wash them with water. That's the way I do it. I don't have hand sanitizer with me. On 08/31/23 at 02:14 PM, during an interview with with Staff I regarding assistance with dining and infection control. Staff I stated, As a nurse, when the trays come to the floor, I have to check the menu list for the diet to make sure it's correct. Then I pass the trays to the CNAs. The procedures for infection control is I have to wash my hands before and after each trays. Review of the facility's Handwashing/Hand Hygiene Policy and procedures Revised August 2019 included: Policy statement: This facility considers hand hygiene the primary means to prevent the spread of infections. Policy interpretation and implementation: 1. All personnel shall be trained and regularly in-serviced on the importance of hand hygiene in preventing the transmission of healthcare-associated infections. 105217 Page 24 of 25 105217 08/31/2023 North Beach Healthcare and Rehabilitation Center 2201 NE 170th Street North Miami Beach, FL 33160

F 0880 Level of Harm - Minimal harm or potential for actual harm 2. All personnel shall follow the handwashing/hand hygiene procedures to help prevent the spread of infections to other personnel, residents, and visitors. 3. Hand hygiene products and supplies (sinks, soap, towels, alcohol-based hand rub, etc.) shall be readily accessible and convenient for staff use to encourage compliance with hand hygiene policies. Residents Affected - Few 6. Wash hands with soap (antimicrobial or non-antimicrobial) and water for the following situations: a. When hands are visibly soiled; and b. After contact with a resident with infectious diarrhea including, but not limited to infections caused by norovirus, salmonella, shigella and and C. difficile. 7. Use an alcohol-based hand rub containing at least 62% alcohol; or, alternatively, soap (antimicrobial or non-antimicrobial) and water for the following situations: o. Before and after eating or handling food; p. Before and after assisting a resident with meals. Procedures Washing Hands: 1. Wet hands first with water, then apply an amount of product recommended by the manufacturer to hands. 2. Rub hands together vigorously for at least 15 seconds, covering all surfaces of the hands and fingers. Rinse hands with water and dry thoroughly with a disposable towel. 4. Use a towel to turn off the faucet. 5. Avoid using hot water, because repeated exposure to hot water may increase the risk of dermatitis. Using Alcohol-based hand rubs: 1. Apply generous amount of product to palm of hand and rub hands together. 2. Cover all surfaces of hands fingers until hands are dry. 3. Follow manufacturers' directions for volume of product to use. 105217 Page 25 of 25