Health inspection·February 13, 2024

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on observation, interview, and record review, the facility failed to ensure scheduled medications were administered as ordered and according to professional standards of practice for 17 of 18 residents reviewed for medication administration out of a total sample of 19 residents, (#1, 4, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18 & 19). Findings: On 2/12/24 at 11:09 AM, Registered Nurse (RN) A was observed at her medication cart on the A wing. She explained she had just finished administering morning medications. She acknowledged the morning medications were administered late. On 2/12/24 at 11:03 AM, Licensed Practical Nurse (LPN) B stated the usual nurse staffing for day shift at the facility was four nurses, two on each wing. LPN B explained that occasionally, like yesterday they were staffed with only 3 nurses so one nurse had a split assignment between the two units. She noted that when this occurred, medications were often given late, as they did not receive help from Administrative staff such as the Director of Nursing (DON), the Unit Managers (UM) or the Minimum Data Set (MDS) nurse. On 2/12/24 at 10:23 AM, RN C stated when a nurse called off, they had only 3 nurses working on the medication carts. She confirmed she did not receive help from the UM or DON to ensure medications were administered timely. On 2/13/24 at 10:35 AM, LPN D was at the medication cart on the A wing. She confirmed she was late in administering medications and indicated she had not yet started on the 1-9 hall of the A wing. She noted the residents in rooms 1-9 would not receive their medication on time. LPN D stated a nurse had called off today and I have been putting out fires all morning. She explained since this was her first time working on the A unit, she did not want to rush and make a mistake. On 2/13/24 at 10:42 AM, the A wing UM stated she did not realize medications were late for 1-9 hall of the A wing. She confirmed with LPN D that she had not yet administered 9:00 AM medications for residents in rooms 1-9 of the A wing, and that LPN D had not asked anyone for help. The A wing UM stated there were nurses available who could assist LPN D to administer medications such as the MDS nurses. The A wing UM stated it was facility policy to administer medications an hour before or an hour after they were scheduled. She stated nurses were supposed to notify the physician if the medications were late and get an order to either hold them or give them late. The A wing UM stated it was best practice to give medications on time and consistently so that medications could work optimally and for best efficacy as the physician ordered. Page 1 of 3 105325 105325 02/13/2024 Space Coast Healthcare and Rehabilitation Center 125 Alma Blvd Merritt Island, FL 32953

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some On 2/13/24 at 11:50 AM, LPN D was observed administering medications on the 1-9 hall of the A wing. She said she was almost finished administering 9:00 AM medications, but no one came to assist her. LPN D stated she did not want to be the one to complain, everyone is late, this is what happens when there is a call out. On 2/13/24 at 12:12 PM, the Director of Nursing acknowledged administration of medications within one hour before and one hour after the scheduled time was the accepted professional standard for nursing practice. Review of the Medication Admin Audit Report for 2/13/24 as of 1:01 PM, revealed the following: Resident #11 as of 1:01 PM on 2/13/24, had not received her 9:00 AM medications including Apixaban 5 milligrams (mg) tablet for atrial fibrillation, Memantine Hydrochloride (HCL)-Donepezil HCl capsule 24 hour 28-10 mg for dementia, Losartan Potassium 50 mg tablet for atrial fibrillation, Metoprolol Tartrate tablet 12.5 mg for atrial fibrillation, Quetiapine Fumarate 25 mg tablet for delusions, and Divalproex Sodium 500 mg tablet for depression, more than four hours late. Resident #1 had not received her scheduled 8:00 AM medication Ribavirin tablet 200 mg for liver cirrhosis until 11:19 AM, more than three hours late. She received her 9:00 AM scheduled medications including Lantus (insulin glargine) Pen- Injector for diabetes mellitus, Gabapentin capsule 100 mg for peripheral neuropathy, Amlodipine Besylate tablet 5 mg for hypertension, Keflex oral capsule 500 mg for Bacteriuria, and Carvedilol tablet 6.25 mg for hypertension after 11:13 PM, more than two hours late. Resident #4 received his 9:00 AM scheduled medications including 10 milliliter (ml) Normal Saline flush of his intravenous line at 12:33 PM, 150 mg of Pregabalin for neuropathy at 12:34 PM, Amiodarone HCl 200 mg tablet at 12:35 PM, and Baclofen 5 mg tablet for muscle spasms at 12:35 PM, three hours late. Resident #8 received his scheduled 9:00 AM medications which included Amlodipine Besylate 5 mg for hypertension, 20 mg of Furosemide tablet for chronic systolic heart failure, and Brimonidine Tartrate Ophthalmic Solution 0.025 % for glaucoma over two hours late at 11:05 AM. Resident #9 received 9:00 AM scheduled Ativan tablet 0.5 mg for anxiety and Norco Oral tablet 5-325 mg for acute pain more than two and a half hours late at 11:38 AM. Resident #10 received her 9:00 AM scheduled medications which included Dorzolamide HCl Opthalmic Solution 2% for glaucoma almost 4 hours late at 12:49 PM. Other 9:00 AM medications she received late that day were Budesonide Oral Capsule 9 mg for acute respiratory failure at 12:47 PM, Amlodipine Besylate 5 mg for hypertension at 12:46 PM, Advair Diskus Inhalation Aerosol at 12:45 PM, Dicyclomine HCl 10 mg capsule for Crohn's Disease at 12:48 PM, Alogliptin Benzoate 25 mg tablet for Type 2 diabetes mellitus at 12:46 PM, Sertraline HCl 50 mg tablet for anxiety disorder, Metoprolol Tartrate 50 mg tablet for hypertension at 12:51 PM, Metformin HCl 1000 mg oral tablet for Type 2 diabetes mellitus at 12:51 PM, and Timolol Maleate Opthalmic Solution 0.5% for glaucoma at 12:54 PM. Resident #12 received his 9:00 AM medications, Furosemide 20 mg tablet for heart failure at 12:24 PM and Amlodipine Besylate 10 mg tablet for hypertension at 12:23 PM, more than 3 hours late. Resident #13 received her 9:00 AM medications, Midodrine HCl 5 mg tablet for hypotension at 12:25 105325 Page 2 of 3 105325 02/13/2024 Space Coast Healthcare and Rehabilitation Center 125 Alma Blvd Merritt Island, FL 32953

F 0755 Level of Harm - Minimal harm or potential for actual harm PM, Escitalopram Oxalate 10 mg oral tablet for depression and Meclizine HCl 12.5 mg tablet for dizziness more than 3 hours late at 12:27 PM. Resident #14 received 9:00 AM scheduled Heparin Sodium injection 5000 unit/ml for therapeutic, and Meloxicam 7.5 mg tablet for inflammation at 12:07 PM, more than three 3 hours late. Residents Affected - Some Resident #15 received ordered 9:00 AM medications, Ciprofloxacin HCl 500 mg tablet for urinary infection, Metoprolol Succinate ER oral tablet 100 mg for hypertension, Amlodipine Besylate 5 mg tablet for hypertension, Doxazosin Mesylate 2 mg oral tablet for hypertension, Dexamethasone tablet 6 mg for symptoms involving musculoskeletal system, and Torsemide 20 mg tablet for acute kidney failure at 11:35 AM, more than two and half hours late. Resident #16 received 9:00 AM ordered Amitriptyline HCl tablet 50 mg for anxiety disorder and 750 mg Keppra tablet for epilepsy at 11:31 PM, more than two and half hours late. Resident #17 received 9:00 AM scheduled Omeprazole tablet 20 mg for gastroesophageal reflux disease at 11:52 AM, almost three hours late. Resident #18 received 9:00 AM Insulin Glargine subcutaneous solution 36 units for antidiabetic at 11:06 AM, more than 2 hours late. Resident #19 received Gabapentin capsule 100 mg for neuropathy pain, Metoprolol Succinate tablet 25 mg for hypertension, Apixaban 5 mg tablet for atrial fibrillation, Lubiprostone 8 micrograms for bowel habit changes and Ticagrelor tablet 45 mg for cerebral infarction at 12:01 PM, three hours late. Review of the Medication Administration Times/Schedules undated provided by the facility revealed once a day medications were scheduled for the time frame 9:00 AM. Twice a day medications were scheduled for 9:00 AM and 9:00 PM. The Administering Medications policy dated April 2013 described medications should be administered in a safe and timely manner and as prescribed. Policy interpretation and implementation included medications must be administered in accordance with orders including any required time frames. 105325 Page 3 of 3