Health inspection·February 1, 2024

F 0583 Keep residents' personal and medical records private and confidential. 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 maintain privacy of residents' personal and medical records for two (Residents #113 and #1) of 34 sampled residents. Residents Affected - Few The findings include: 1. On 02/01/24 at 9:49 a.m., a computer on the nurse's medication cart on the west wing hallway was observed to be unlocked. The computer screen displayed the medical record for Resident #113. The record revealed the resident's physician's orders, physician, and room number. (Photographic evidence obtained) Licensed Practical Nurse (LPN) D was observed exiting Resident #113's room on 02/10/24 at 9:53 a.m. She stated she had to give the resident his medication and forgot to close the computer. 2. On 02/01/24 at 9:59 a.m., the door to room [ROOM NUMBER] was observed with a yellow poster indicating that the resident in 318 bed A was NPO (nothing consumed by mouth) on 02/01/24. The resident's name was also displayed on the door identifying the resident in 318 bed A as Resident #1. In an interview on 02/01/24 at 11:03 a.m. with LPN E, she stated Resident #1was having an abdominal ultrasound and needed to be NPO. When asked about the sign on the door, she stated it should not have been placed there. During an interview with the Director of Nursing (DON) on 02/01/24 at 11:07 a.m., she stated the computer should be locked while the nurse is away from it. When asked about the sign on the door for room [ROOM NUMBER], she stated it should not have been there. She added that the staff should communicate the residents' information during report and the morning huddle meeting. A review of the facility's policy and procedure titled Confidentiality of Medical Information, Policy Number NM 11-10, effective October 1, 2010, revealed that the policy's purpose indicated that the resident had the right to privacy and confidentiality of clinical information. The policy standard read: The facility should keep confidential all information contained in a resident's record, regardless of the form of storage or location of the record, except when release is required to another health care facility or by law. To maintain confidentiality of resident medical information, employees should exercise caution during discussion of a confidential nature with the resident, in using medical record information for documentation purpose, and in the use of signs or care reminder information sheets that may be posted in the resident's room. . Page 1 of 6 105311 105311 02/01/2024 Daytona Beach Health and Rehabilitation Center 1055 3rd Street Daytona Beach, FL 32117

F 0625 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews and staff interview, the facility failed to provide a notice of its bed hold policy prior to transfer of a resident to an acute-care facility to two (Residents #8 and #189) of a total sample of 34 residents. The facility also failed to provide a bed hold policy to 22 (Residents #201, #115, #273, #48, #44, #104, 1, #74, #123, #117, #136, #226, #339, #105, #16, #70, #19, #249, #112, #262, #120, and #9) of 22 additional residents transferred to an acute-care facility who were listed in the facility's January 2024 Discharge Report. The findings include: 1. A review of Resident #8's medical record revealed that she was admitted to the facility on [DATE]. Her diagnoses included, but were not limited to, convulsions, genetic torsion dystonia (sustained muscle contractions), tremors, salivary secretions, a history of traumatic brain injury, cauda equina syndrome (lower spinal cord pressure and swelling), dysphagia, and language deficit. A review of a nursing progress note, dated 12/10/23, revealed that the resident was transferred to the hospital after choking during a meal. There was no indication in the record that a bed hold policy had been provided at the time of the resident's transfer to the hospital. 2. A review of Resident #189's medical recored revealed that he was admitted to the facility on [DATE] with diagnoses including, but not limited to schizophrenia, a history of alcohol abuse, bipolar disorder, a history of cannabis abuse, and a fracture of the lower end of the tibia. A review of a nursing progress note, dated 09/07/23, revealed that Resident #189 had been transferred out of the facility via [NAME] Act (involuntary psychiatric admission) due to the endangerment of other residents/staff in the facility. There was no indication in the record that a bed hold policy had been provided at the time of the resident's transfer to the hospital. A review of the facility's Discharge Report for the period of 01/01/24 through 01/31/24, revealed that the facility transferred 24 residents to an acute care facility during that time: Residents #201, #115, #273, #48, #44, #104, 1, #74, #123, #117, #136, #226, #339, #105, #16, #70, #19, #249, #112, #262, #120, and #9. (Copy obtained) On 02/01/24 at 1:05 p.m., an interview was conducted with the Social Services Director (SSD), and she was asked to provide a copy of the bed hold policy that had been provided to Residents #8 and #189 at the time of transfer. She stated she was not responsible for providing the bed hold policy to the residents. She stated she would ask the Director of Nursing (DON) who was responsible for providing that information. On 02/01/24 at 1:17 p.m., the SSD returned and stated per the DON, no one was completing the bed hold policy forms or providing them to the residents as required. She added that going forward, she would be the one responsible for that task. 105311 Page 2 of 6 105311 02/01/2024 Daytona Beach Health and Rehabilitation Center 1055 3rd Street Daytona Beach, FL 32117

F 0625 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some A review of the facility's policy and procedure titled Transfer, Discharge and Therapeutic Leave (including AMA (against medical advice), Policy Number NM 11-18, effective June 6, 2019, Page 2 III Emergency transfer/discharges, revealed that emergency transfers should occur only for medical reasons, or for the immediate safety and welfare of a resident/guest, or other residents/guests. Emergency transfer procedures should include the following: a. Obtain physician's orders for emergency transfer or discharge, stating the reason the transfer or discharge is necessary on an emergency basis. b. Contact an ambulance service and provider hospital, at facility of resident/guest's choice, for transportation and admission arrangements. c. Complete and send with the resident/guest a transfer form which documents diagnosis, reason for transfer/discharge, date, time, physician, current medications, treatments, functional status, and any special care needs and care plan goals. e. The original copies of the transfer form and advanced directives accompany the resident/guest. Copies are retained in the medical record. f. Document information regarding the transfer in the medical record. g. A copy of the resident/guest bed hold policy and admission policies/transfer to hospital notice should be provided upon transfer by the assigned nurse to the resident and/or representative of the resident. . 105311 Page 3 of 6 105311 02/01/2024 Daytona Beach Health and Rehabilitation Center 1055 3rd Street Daytona Beach, FL 32117

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** Based on observations, staff interview, record review, and facility policy review, the facility failed to ensure that a resident who required respiratory care was provided such care, consistent with professional standards of practice, and the comprehensive care plan for one (Resident #389) of a total sample of 34 residents. Residents Affected - Few The findings include: On 01/29/24 at 12:23 PM, Resident #389 was observed sitting up in bed with oxygen infusing at 3.5 liters per minute via nasal cannula. Resident #389 stated, My oxygen is set at 4 liters. On 01/30/24 at 10:50 AM, Resident #389 was observed lying in bed with oxygen infusing at 3.5 liters per minute via nasal cannula. (Photographic evidence obtained) On 01/30/24 at 3:30 PM, Resident #389 was observed lying in bed with oxygen infusing at 3.5 liters per minute via nasal cannula. (Photographic evidence obtained) A review of Resident #389's record revealed that he was admitted to the facility on [DATE] with diagnoses including but not limited to chronic obstructive pulmonary disease (COPD), acute respiratory failure with hypoxia, chronic respiratory failure with hypoxia, chronic respiratory failure with hypercapnia, and a dependence on supplemental oxygen. A review of the minimum data set (MDS) assessment with a reference date of 01/25/24 revealed that it was incomplete, in progress, and that the resident was a new admission. A review of the resident's 01/25/24 admission physician's orders revealed the following: Oxygen, 4 liters continuously via nasal cannula for chronic respiratory failure. A review of the care plan dated 1/26/24 revealed the following: FOCUS: Receiving oxygen therapy, continuous at 4 L/min (four liters of oxygen per minute). Goal: I will exhibit no shortness of breath x 90 days. Interventions included but were not limited to: Administer oxygen therapy as ordered. A review of the resident's progress notes from 01/25/24 through 02/01/24, revealed: 01/30/24 06:19 AM Resident is total care, 02 (oxygen) on per order. On 02/01/24 at 1:10 PM, an interview was conducted with Licensed Practical Nurse (LPN) F, who stated she had been trained to administer oxygen but she could not recall how recently that occurred. I can't say I have not had training, it's almost common sense, but we have had in-services and I'm sure oxygen has come up. When she was asked how the correct oxygen flow rate settings were communicated from one staff person to another, she said oxygen flow rate/settings information was passed on during change-of-shift report from nurse to nurse along with the resident's current condition. LPN F further stated she would check the orders against the flow rate setting every time she went into the resident's room. When she was asked about the certified nursing assistants' (CNAs') role regarding residents' oxygen therapy, LPN F stated, the CNAs don't really play a role except to know how many 105311 Page 4 of 6 105311 02/01/2024 Daytona Beach Health and Rehabilitation Center 1055 3rd Street Daytona Beach, FL 32117

F 0695 liters the resident is receiving, so they can be our eyes on the floor. Level of Harm - Minimal harm or potential for actual harm A review of the facility's Nursing Procedures Manual revealed the following: Advanced Care Procedures, Policy Title: Oxygen Administration (Policy number: NP.VI-58, Effective date: December 8, 2005, Sepersedes: NP.VI-58 - Nov. 1, 2001), Page one of one - Purpose: To administer high purity oxygen for the treatment of certain diseases or conditions. Standard: Oxygen should be administered under orders of the attending physician, except in case of an emergency. Process: 1. Obtain physician's orders for the rate of flow and route of administration of oxygen. 8. Check oxygen flowmeter for correct liter flow. Residents Affected - Few . 105311 Page 5 of 6 105311 02/01/2024 Daytona Beach Health and Rehabilitation Center 1055 3rd Street Daytona Beach, FL 32117

F 0842 Level of Harm - Minimal harm or potential for actual harm Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Based on observation, interview, and record review, the facility failed to ensure that the resident's record was accurately documented for one (Resident #71) of a total of 34 residents sampled. Residents Affected - Few The findings include: During a medication administration observation on 01/31/24 at 9:30 a.m., Licensed Practical Nurse (LPN) D stated the bumetanide (diuretic) for Resident #71 was not in the medication cart. She went to the emergency drug kit (EDK) and confirmed that the medication was not listed as available in the EDK. She said she would have to contact the Advance Practice Nurse Practitioner (ARNP). On 01/31/24 at 10:10 a.m., LPN D contacted the ARNP who stated he ordered bumetanide on 1/24/24 and asked the nurse to contact the pharmacy and get the estimated time of arrival (ETA) before he could write new orders. LPN D called the pharmacy and was informed that the pharmacy had not received the order for bumetanide. She was asked to send a new order. On 01/31/24 at 10:17 a.m., LPN D was asked to review the medication administration record (MAR) for Resident #71. She confirmed that bumetanide 1 milligram (mg) every day was marked as having been administered from 1/25/24 through 1/30/24 by LPN B. During an interview with the Director of Nursing (DON) on 02/01/24 at 11:07 a.m., she stated she was made aware of the issue. . 105311 Page 6 of 6