Health inspection·July 21, 2021

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 Based on observation, interview, and record review, the facility failed to provide adequate activities of daily living (ADL) care for 1 of 2 dependent residents of a total sample of 47 residents, (#74). Residents Affected - Few Findings: Resident #74 was re-admitted to the facility from an acute care hospital on 3/25/21. Her diagnoses included Parkinson's disease, dementia, joint disease and muscle weakness. The resident's significant change Minimum Data Set (MDS) assessment with Assessment Reference Date 7/1/21 revealed no history of rejection of care. Her Brief Interview for Mental Status (BIMS) score was 5/15 which indicated she was severely cognitively impaired. The resident required extensive assistance of 1 staff with her personal hygiene and was totally dependent on staff for bathing. The resident's care plan for ADL self-care performance deficit revised on 7/8/21 noted interventions that included, Bathing: The resident needs limited assistance on staff for personal hygiene This care plan contradicted the most recent MDS assessment that noted she needed extensive assistance. 07/21/21 at 12:31 PM, the MDS Coordinator acknowledged the ADL care plan was not updated after the most recent significant change MDS assessment was completed. She said resident #74 had a decline and now needed extensive assistance for personal hygiene. On 7/18/21 at 11:25 AM, resident #74 was lying in bed. Her fingernails were dirty with brownish/orange colored debris under the nails. Resident #74 was observed again on 7/18/21 at 12:30 PM eating lunch while in bed and her fingernails remained dirty with orange/brown residue noted under the nails. On 7/18/21 at 3:45 PM, resident #74 was resting in bed and her fingernails remained the same. On 7/19/21 at 12:25 PM, resident #74 was sitting up in bed eating lunch with her fingers and her fingernails remained dirty with brownish/orange residue present under nails and around the cuticles. The Director of Nursing (DON) walked into the room and observed the resident eating her lunch with dirty hands/fingernails. The DON said they used to have wipes for residents to use prior to eating to clean their hands. On 7/20/21 at 12:05 PM, the resident was lying in bed with untouched lunch tray on the over-bed table. Certified nursing assistant (CNA) A was in the room and acknowledged the resident's dirty hands (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 4 Event ID: 105307 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105307 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/21/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Rehabilitation Center at Winter Park 2075 Loch Lomond Drive Winter Park, FL 32792 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)