Health inspection·September 14, 2023

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and interview, the facility failed to develop a comprehensive care plan related to activities for 1 of 1 sampled resident who was dependent on the staff for access to activities (Resident #1). The findings included: During observations on 09/11/23 at 12:24 PM, 09/11/23 at 4:21 PM, 09/12/23 at 2:40 PM, 09/13/23 at 12:05 PM, 09/13/23 at 3:12 PM, and 09/14/23 at 1:39 PM, Resident #1 was observed not participating in any type of activity. Review of the record revealed Resident #1 was admitted to the facility on [DATE]. Review of the current Minimum Data Set (MDS) assessment, dated 08/25/23, documented Resident #1 had a Brief Interview for Mental Status (BIMS) score of 5, on a 0 to 15 scale, indicating he was cognitively impaired. The MDS documented Resident #1 needed extensive to total assistance from staff for all Activities of Daily Living (ADLs), except eating. This MDS also documented that staff assessed Resident #1's preferences for activities that included music, pets, news, group activities, time away from the nursing home, and time outdoors. Further review of the record lacked any care plan related to activities for Resident #1. During an interview on 09/13/23 at 9:21 AM, the Activities Manager reported the MDS Nurse was responsible for all resident care plans. During an interview on 9/13/23 at 4:00 PM, the MDS Coordinator reported the Activity Manager completes the preference section of the resident assessment and develops the resident care plan based upon the assessment. During a subsequent interview on 09/14/23 at 10:33 AM, the Activities Manager clarified that she was responsible for the MDS section related to Activity Preferences, and develops the activities portion of the resident's care plan. The Activities Manager agreed with the lack of a care plan related to activities for Resident #1. Page 1 of 4 105259 105259 09/14/2023 Medicana Nursing and Rehab Center 1710 Lake Worth Road Lake Worth, FL 33460

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record review, and policy review, the facility failed to ensure proper care and services to prevent infection or other complications for 2 of 2 sampled residents with indwelling urinary catheters. Staff failed to provide proper perineal and catheter care, ensure proper anchoring of the catheter tubing, ensure a complete written order, and follow Enhanced Barrier Precautions (EBP) for Resident #4. The record lacked an appropriate order for the indwelling urinary catheter for Resident #40. The findings included: Review of the policy titled, Indwelling Catheter Care revised [DATE] documented, Maintenance: . Keep the drainage tube and collection bag lower that bladder. This policy further explained the need for two separate basins of water, one for catheter care and one for perineal care, cleansing the tubing away from the insertion site, avoid pulling on the catheter while cleaning it, and to provide slack while securing the catheter to the resident's thigh. As per Centers for Disease Control and Prevention (CDC), Enhanced Barrier Precautions (EBP) include the use of both gloves and gowns during resident care, to include residents with urinary catheters. 1) An observation of perineal and urinary catheter care for Resident #4 was made on [DATE] at 10:03 AM, with Staff B, Certified Nursing Assistant (CNA), who was assigned to care for the resident, and with the assistance of Staff C, Restorative CNA, to help position the resident. Upon entering the room, a sign on the door documented Enhanced Barrier Precautions, instructing direct care staff to don both gloves and gowns while providing care, to include urinary catheter care. At no time during the observation did either CNA don a gown. Staff B, direct care CNA, obtained the needed supplies for care while Staff C readied the resident for the care. Upon removal of the covers, the urinary catheter tubing was noted taunt from the resident to the right side of the resident's bed. The anchor clip had become dislodged from the anchor patch attached to the resident's thigh, thus not securing the tubing. During care, the clip slipped up the tubing toward the resident, all the way to the insertion site, at which time Staff B simply moved the clip back away from the resident to continue care. Staff B provided perineal care and urinary catheter care, utilizing two water basins, one for soapy washing water and the other for rinsing. Staff B utilized the same wash washcloth and the same rinse washcloth throughout the entire process. While cleansing the urinary catheter tubing, Staff B failed to secure the tubing at the insertion site, failed to only cleanse away from the insertion site, and maintained the tubing in a taunt position. Upon completion of the care, the two CNAs turned Resident #4 to his left side, and failed to ensure slack in the tubing. During a subsequent observation on [DATE] at 3:53 PM, Resident #4 was sitting up in his wheelchair, wearing long pants, and the urinary catheter tubing was noted coming out of the top of the resident's pants at the waist level, with the anchor clip noted at the waistband, but not secured to the anchor pad. On [DATE] at 4:01 PM, the North Unit Manager was asked to observe Resident #4. Upon entering the room, the North Unit Manager immediately identified the tubing running up higher than the resident's bladder. The North Unit Manager agreed the tubing should be anchored to the anchor thigh. The North 105259 Page 2 of 4 105259 09/14/2023 Medicana Nursing and Rehab Center 1710 Lake Worth Road Lake Worth, FL 33460

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Unit Manager was made aware that the urinary catheter tubing was not secured to the resident's thigh during the observed care earlier that same day, and that the anchor clip had been dislodged at that time. When told of the observed personal care by Staff B, CNA, the North Unit Manager agreed with the improper care. Review of the record revealed Resident #4 was admitted to the facility on [DATE]. Review of the current Minimum Data Set (MDS) assessment dated [DATE] documented Resident #4 had a Brief Interview for Mental Status (BIMS) score of 3, on a 0 to 15 scale, indicating he was cognitively impaired. This MDS documented Resident #4 had a urinary catheter and had had a Urinary Tract Infection (UTI) within the past 30 days. Further review of the record lacked any order that documented the type and size of urinary catheter for Resident #4. Review of the current care plan initiated [DATE] revealed Resident #4 had an indwelling catheter. Interventions included to attach leg strap to leg to prevent tugging and pulling of the catheter, proper positioning of the tubing to maintain lower than waist level, along with the use of enhanced barrier precautions. During an interview on [DATE] at 10:38 AM, when asked how she would know the type (i.e. Foley, suprapubic, or condom) and size of a urinary catheter a resident had, Staff D, Licensed Practical Nurse (LPN), stated there would be a physician's order. Upon review of the record, Staff D was unable to locate an order for the type or size of Resident #4's indwelling catheter. 2) During an observation on [DATE] at 10:13 AM, Resident #40 was noted in bed. A urinary drainage device was noted to bedside drainage. During a subsequent interview at 11:00 AM, Resident #40 was unable to inform the surveyor of the type or reason for the urinary catheter. Review of the record revealed Resident #40 was admitted to the facility on [DATE]. Review of the Minimum Data Set (MDS) assessment dated [DATE] documented Resident #40 had an indwelling urinary catheter. Review of the current physician orders lacked the type or size of the indwelling catheter in use for Resident #40. Review of the current care plan initiated [DATE] documented Resident #40 had an indwelling catheter related to neurogenic bladder. During the continued interview on [DATE] at 10:51 AM, Staff D, LPN, was unable to locate an order for the urinary catheter with the type or size documented. 105259 Page 3 of 4 105259 09/14/2023 Medicana Nursing and Rehab Center 1710 Lake Worth Road Lake Worth, FL 33460

F 0770 Provide timely, quality laboratory services/tests to meet the needs of residents. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to collect a physician ordered stool sample for 1 of 1 sampled resident, who was having active diarrhea during her facility stay (Resident #79). Residents Affected - Few The findings included: Review of the record revealed Resident #79 was admitted to the facility on [DATE], and passed away on 07/18/23. Review of the physician orders revealed an order dated 06/29/23 for staff to collect a stool sample for possible C-diff (clostridioides difficile, a bacterial infection of the colon). Further review of the record lacked any documentation of the attempt or inability to collect the stool sample, or any laboratory results for the test. Review of the Certified Nursing Assistant (CNA) documentation for bowel movement results between 06/29/23 and 07/18/23 revealed four documented medium sized watery and loose (liquid form) stools and 13 large watery and loose (liquid form) stools. During an interview on 09/14/23 at 11:38 AM, the South Unit Manager stated she did not recall, but believed the order may have been entered into the record by mistake. As the Unit Manager hovered over the electronic record order, she believed the order was both entered and discontinued on 06/29/23. Further review of the electronic order documented it was created in the electronic record on 06/29/23, set to be completed in two days as of 07/01/23, and was not discontinued. 105259 Page 4 of 4