Health inspection·September 18, 2024

F 0687 Provide appropriate foot care. Level of Harm - Minimal harm or potential for actual harm Based on record review, observation, and interviews, the facility failed to ensure consistent podiatry services were provided to one (#3) of ten sampled residents. Residents Affected - Few Findings included: A review of Resident #3's clinical chart, the face sheet reflected an admission of 01/2024. Medical diagnoses included Alzheimer's disease and need for assistance with personal care. A review of Resident #3's Care Plan reflected a focus area: ADL (Activity of Daily Living): (Resident #3) has an ADL Self Care Performance Deficit r/t Dementia, low back pain. Interventions included: -Dressing: Mod (moderate) Assist of 1 -Bathing: The resident requires set up with supervision of 1 -Report changes in ADL performance to Nursing. A review of Resident #3's progress notes reflected the most recent note prior to the date of survey on 09/18/2024 was 09/05/2024, a Nutrition note. A review of Weekly skin checks reflected assessments had been completed on 09/17/2024 at 21:58 and 09/10/2024 at 16:40, which documented Resident #3 had no new skin conditions. A review of shower documentation reflected Resident #3 had received showers on the following recent dates: -09/16 -09/13 -09/11 -09/09 On 09/18/2024 at 10: 10 a.m., in the secure unit area, Resident #3 was observed sitting in the main dining room, in a regular chair, his back against the wall, he was observed to have his left leg Page 1 of 3 105327 105327 09/18/2024 Casa Mora Rehabilitation and Extended Care 1902 59th St W Bradenton, FL 34209

F 0687 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few bent and his foot upon his knee. He was observed from across the dining room to be vigorously scratching his foot. A Certified Nursing Assistant, (CNA), Staff A, was observed approaching him and offering to put socks on him. Resident #3 was observed to have a dime sized dark reddish-brown thick scab with the skin reddened around the scab on the middle of the top of his foot. Additional scratch marks were visible on the foot. On the right leg, mid-calf, down towards the ankle, little red marks were scattered. Staff A, CNA, was interviewed at this time, she stated she did not know why the resident was scratching. At 10:12 a.m., on 09/18/2024 Staff B, Licensed Practical Nurse (LPN) was interviewed. She was asked about Resident #3's scratching. She stated, he does not have any treatment at this time. She was observed to walk over to Resident #3 and ask him if she could take him to his room to review. They were observed to leave the common area and proceed to the resident's room. Staff B, LPN was observed to review Resident #3's feet and ankle area. She said, it looks a little red. I am going to get the physician assistant (PA) to look at it. At 10:18 a.m., on 09/18/2024 Staff C, Registered Nurse (RN) was observed to come into Resident #3's bedroom. She was observed to review Resident #3's feet, ankles, and lift his pant legs to review his lower legs. She stated she was just filling in, one of the unit managers was out. Resident #3 was interviewed at this time. He stated the itching had been going on for a while, but he was unable to specify the length of time. He stated it hurts. Yes, I told someone before. He was unable to say who he had told. Resident #3's bare feet were observed. His toenails were long, approximately ¼ inch beyond the nail bed, dark on the underneath in appearance. An interview was conducted on 09/18/2024 at 10:35 a.m. with the Director of Nursing (DON). When asked how the CNAs report skin conditions that they may see when giving a resident a shower. She stated, if CNA's notice, they report to the nurse. The nurses do a weekly skin check, that is in the chart. For the fingernails, we can cut. For the toenails, podiatry services are used. Social Services put the residents on the schedule. An interview was conducted on 09/18/2024 at 11:10 a.m. with the Social Service Director (SSD) She provided the list of residents that had been seen by the podiatrist for the following dates: -08/14/2024 -09/04/2024 -09/11/2024 Review of the podiatry lists provided reflected Resident #3's name was not present on the list. When asked how the residents names get to be on the podiatry list, she stated, the staff will come and tell her. I have a clip board in my office they can put the resident's name on. When asked how she informs the staff of what the process was for staff to know to come to her for putting a resident on podiatrist services list. She stated she talks to them a lot. But offered no specific rhetoric in regard to ensuring staff were aware of the process. She stated, I see what you mean. 105327 Page 2 of 3 105327 09/18/2024 Casa Mora Rehabilitation and Extended Care 1902 59th St W Bradenton, FL 34209

F 0687 On 09/18/2024 at approximately 4:30 p.m., the SSD was re-interviewed. She stated the last time Resident #3 was seen by the podiatrist service was on May 3rd, 2024. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 105327 Page 3 of 3