Health inspection·November 10, 2021

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to provide dignity during dining for 1 of 8 residents reviewed for dignity, Resident #57. Findings included: The facility's policy titled Promoting/Maintaining Resident dignity during Mealtimes, implemented 11/2017, documented, It is the practice of this facility to treat each resident with respect and dignity and care for each resident in a manner and in an environment that maintains or enhances his or her quality of life, recognizing each resident's individuality and protecting the rights of each resident. Under the heading titled Policy Explanation and Compliance Guidelines the policy documented: 1. All staff members involved in providing feeding assistance to residents promote and maintain resident dignity during mealtimes 5. All staff will be seated, if possible, while feeding a resident. Resident #57 was admitted on [DATE] and most recently readmitted on [DATE]. According to the resident's most recent complete assessment, a Significant Change Minimum Data Set (MDS), dated [DATE], Resident #57 had a Brief Interview for Mental Status (BIMS) score of 10, indicating that the resident's cognition was 'moderately impaired'. The MDS documented that the resident required 'Limited assistance' and 'one person physical assist' for eating and that the resident had 'impairment on one side' of upper extremity. Resident #57's diagnoses at the time of the assessment included: Hypertension; GERD; Diabetes Mellitus; Arthritis; Non-Alzheimer's Dementia; Parkinson's Disease; Psychotic disorder; Cerebrovascular Disease; and Altered Mental Status. Resident #57's care plan, initiated on 01/13/21 and most recently revised on 11/05/21, documented, Resident requires assistance with all ALD's task performance R/T hx (related to history of ) hospitalization, weakness, abnormalities of gait and mobility. HTN, glaucoma, hx of insomnia, dementia, Osteoarthritis, s/o falls, esophageal reflux, CVA, Parkinson's , hx Anemia, hx functional decline, diabetes, psychosis, adjustment disorder with depressed mood. The goal of the care plan was documented as, Resident will be dressed, clean, dry, odor free and well groomed daily through the next review date with a target date of 01/01/22. Page 1 of 9 105360 105360 11/10/2021 Tamarac Center for Rehabilitation and Healing 7901 NW 88th Avenue Tamarac, FL 33321

F 0550 Interventions to the care plan were documented as: Level of Harm - Minimal harm or potential for actual harm * Assist resident with eating as needed. Monitor and documented % taken at each meal time. Encourage completion of meals. Residents Affected - Few * Assist with all ADL tasks as needed. * Encourage resident to participate as much as tolerated. On 11/07/21 at 12:20 PM Staff A, CNA was observed standing over resident to the resident's left side of bed while feeding Resident #57. It was noted that there was a chair in the room next to the resident's left side of the head of bed and directly behind Staff A, that was not being used for any purpose during the observation. On 11/07/21 at 12:26 PM, Staff A was observed sitting in the chair at resident's left side of bed while feeding Resident #57. On 11/07/21 at 12:34 PM, Staff A was observed standing over Resident #57 while feeding and providing fluid, with the room chair directly behind Staff A. On 11/09/21 at 8:26 AM, Resident #57 was observed in bed with the head of bed elevated, drinking coffee with breakfast on over bed table in front of the resident, with no staff in room to provide assistance or cueing. Resident #57 was noted to have food particles on outer clothing and blanket. During an interview on 11/09/21 at 8:45 AM with the Rehab Manager, when asked for clarification of the MDS that documented that Resident #57 required 'limited assistance' and 'one person physical assist', the Rehab Manager replied that the need for 'limited assistance' and 'one person physical assist' was based on behaviors and that sometimes the resident would do very well with feeding himself. On 11/09/21 at 12:35 PM, Staff B, CNA, was observed standing to resident's right side of bed and feeding the resident lunch from the over bed table that was positioned on the same side of the bed, while standing over the resident. It was noted that the room chair was on the resident's left side of bed and was not being used for any other purpose. During an interview, on 11/09/21 at 12:50 PM, with Staff B, when asked about the facility's policy for feeding a resident, Staff B replied, We take the tray to them and we set them up and we feed them. The ones that can't eat, we feed them. We set up the tray, we put the tray across the table so that we are able to feed them. We sit. He is the way he is, we put the tray across and he said that he didn't want to eat, he ate everything. He loves his food. Resident #57 was not interviewable. 105360 Page 2 of 9 105360 11/10/2021 Tamarac Center for Rehabilitation and Healing 7901 NW 88th Avenue Tamarac, FL 33321

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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to provide fingernail care for 1 of 1 resident reviewed for Activities of Daily Living (Resident #1). Residents Affected - Few The findings included: Review of the facility's policy titled, Nail Care, dated October 2019, documented the following: Routine cleaning and inspection of nails will be provided during activities of daily living (ADL) care on an ongoing basis. Review of the Duties & Responsibilities section of the Certified Nursing Aide Job Description documented the following: Gives hygienic care: bathing, assisting with cleaning teeth, back rubs, providing water to wash hands and face, nail care, combing hair. Review of the record showed that Resident #1 was readmitted to the facility on [DATE] with the following diagnoses: Cerebral Infarction, Altered Mental Status, Rheumatoid Arthritis. Review of Section C of the Minimum Data Set (MDS) dated [DATE] documented that Resident #1 had a Brief Interview for Mental Status score of 15, which indicated that she was cognitively intact. Review of Section G of the MDS dated [DATE] documented that Resident #1 required extensive assistance with one-person physical assist for personal hygiene. Review of the Care Plan dated 09/28/21 documented that Resident #1 had an ADL self-care performance deficit. Interventions were to check nail length and trim and clean on bath day and as necessary. Review of the Certified Nursing Assistant (CNA) Tasks for Nail Care dated 11/07/21 - 11/08/21 documented that nail care was done daily. During an observation conducted on 11/07/21 at 12:16 PM, Resident#1's fingernails were past her fingertips. Closer observation showed Resident #1's fingernails had a noticeable black discoloration under her nails. Resident #1 stated, They haven't cut my nails since I've been here. I don't like them long. When asked if she would like them trimmed, she said Yes. During an interview conducted on 11/08/21 at 3:20 PM, Resident #1 stated no one came in to do her nails. She further stated, They're the same as yesterday. It was noted that Resident #1's fingernails were still past her fingertips and still had a noticeable black discoloration underneath. During an interview conducted on 11/09/21 at 9:14 AM, Staff C, CNA, stated that CNAs were responsible for cleaning and cutting residents' fingernails. When asked how often fingernails were cleaned and cut, she stated, Whenever we see that they're long or dirty when we're doing care. According to her, nail care was documented under CNA Tasks for Nail Care. She stated that if it was marked yes, that would mean that the nails were cleaned. When asked about Resident #1, she stated, I know Staff D, Registered Nurse, was cutting nails last week. During an interview conducted on 11/09/21 at 9:17 AM, Staff D stated that CNAs are normally responsible for cutting and cleaning residents' fingernails, and that it was part of their tasks. She stated she does trim residents' fingernails sometimes, and when she does she informs the CNA. She further 105360 Page 3 of 9 105360 11/10/2021 Tamarac Center for Rehabilitation and Healing 7901 NW 88th Avenue Tamarac, FL 33321

F 0677 Level of Harm - Minimal harm or potential for actual harm stated that if a resident refused nail care, she would document it in the progress notes. When asked about Resident #1, she stated, I think I cut her nails 2 weeks ago. During an observation conducted on 11/09/21 at 9:24 AM, accompanied by Staff C, Resident #1's fingernails were still past her fingertips and still had a noticeable black discoloration underneath. Residents Affected - Few Staff C stated, They didn't look like that on Saturday. She further stated Resident #1's fingernails might be dirty because she might get food under them when she eats. She then acknowledged Resident #1's nails were long, dirty, and said that she would clean and cut her nails. 105360 Page 4 of 9 105360 11/10/2021 Tamarac Center for Rehabilitation and Healing 7901 NW 88th Avenue Tamarac, FL 33321

F 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to provide services to prevent further decrease in range of motion for 1 of 1 resident reviewed for limited range of motion, Resident #33. The findings included: The facility's policy titled, Prevention of Decline in Rang of Motion, implemented 11/2014, documented:, Section 3, Appropriate Care Planning b. The facility will provide treatment and care in accordance with professional standards of practice. This includes, but Is not limited to: ii. Appropriate equipment e. A nurse with responsibility for the resident will monitor for consistent implementation of the care plan interventions. Refusals of care or problems associated with range of motion exercises will be documented in the medical record. Section 4 Preventive Care b. Staff will be educated on basic, restorative nursing care that does not require the use of a qualified therapist or licensed nurse oversight. This training may include but is not limited to: iv. Assisting residents in adjustment to their disabilities and use of any assistive devices. Resident #33 was admitted on [DATE]. According to Resident #33's most recent complete assessment, a Quarterly Minimum Data Set (MDS), dated [DATE], Resident #33 had a Brief Interview for Mental Status score of 13, indicating 'cognitively intact'. The MDS documented that the resident was dependent upon staff for Activities of Daily Living (ADLs). The assessment documented that the resident used an indwelling catheter and was 'frequently incontinent' of bowel'. Resident #33's diagnoses at the time of the assessment included: Anemia; Heart Failure; Hypertension; Obstructive Uropathy; Diabetes Mellitus; Non-Alzheimer's Dementia; Seizure disorder; Anxiety disorder; Depression; Dependence on renal dialysis; Hemiplegia following cerebral infarction affecting left dominant side. Resident #33's orders included: Left hand roll on at all times remove for hygiene only every shift related to Hemiplegia and hemiparesis following cerebral infarction affecting left dominant side - 10/12/21. Review of Resident #33's electronic and paper-based health record revealed no documentation of Resident #33 being noncompliant with the use of a splint/device to the left hand. During an interview with Resident #33, on 11/07/21 at 1:21 PM it was noted that the resident's left hand was contracted with a device on the left lower arm at the wrist. The resident stated, it's not 105360 Page 5 of 9 105360 11/10/2021 Tamarac Center for Rehabilitation and Healing 7901 NW 88th Avenue Tamarac, FL 33321

F 0688 supposed to be like that, it's supposed to be under my fingers. Level of Harm - Minimal harm or potential for actual harm On 11/08/21 at approximately 12:15 PM, Resident #33 was observed in bed with the splint around the resident's left lower arm/wrist. Residents Affected - Few On 11/09/21 at 8:38 AM, Resident #33 was observed in bed with breakfast on over bed table, eating independently. It was noted that the resident's splint was around the left lower arm/wrist. During an interview, on 11/09/21 at 8:38 AM, with the Rehab Manager, when asked about Resident #33's splint to the left hand, the Rehab Manager replied, they (CNAs) take it off during any kind of AM care and should be taken off at night. She had another splint that she refused so we discharged that. It is supposed to be around her hand and under her fingers to keep her fingernails from digging in. She (Resident #33) fidgets a lot and moves the splint there. On 11/09/21 at 10:50 AM, Resident #33 was observed in bed and was asked if the staff had placed the splint properly, Resident #33 replied, they were supposed to come back after I finished eating and he never came back. Resident #33 held up the left hand and the brace was at the resident's left lower arm/wrist. When the resident was asked of the ability to move and place the splint independently, Resident #33 stated she was not able to. During a follow up interview, on 11/09/21 at 10:57 AM, with the Rehab Manager, the Rehab Manager stated, the CNAs and whoever is in the room should recognize the splint and replace it as needed. The ADON helped place it on Sunday, she (Resident #33) gets agitated and fidgets with it. During an interview, on 11/10/21 at 10:36 AM, with Staff B, CNA, when asked about maintaining Resident #33's splint device, Staff B replied, we are supposed to get a new one and put it on her hand. We get her a new one so that she has a clean one. She moves around in bed a lot and sometimes it gets moved around and out of place. During an interview, on 11/10/21 at 11:35 AM, with Staff C, LPN, when asked about the facility's policy for maintaining a resident's range of motion and devices, Staff C replied, Just as far as making sure that the CNAs provide care to that hand and clean inside of it, they are supposed to do that every shift. They are supposed to check every 3 hours and clean underneath if it (splint, device) needs to be, shifts are 8 hours. If it is fine when they check, they can leave it off for thirty minutes and go back to put it back on after they have cleaned it and the hand. 105360 Page 6 of 9 105360 11/10/2021 Tamarac Center for Rehabilitation and Healing 7901 NW 88th Avenue Tamarac, FL 33321

F 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to obtain daily weights as per Physician's Orders for 3 of 7 residents reviewed for nutrition (Resident #280, Resident #283, Resident #330). Residents Affected - Few The findings included: Review of the facility's policy titled, Weight Assessment/Evaluation and Intervention, dated August 2018, documented the following: The nursing staff will obtain weights on the newly admitted resident for 3 days, beginning the morning after admission, and weekly for 4 weeks. Weight will be recorded in the individual's medical record/electronic medical record. 1. Review of the record showed that Resident #280 was re-admitted to the facility on [DATE] with the following diagnoses: Protein-Calorie Malnutrition, Underweight, Stage 3 Chronic Kidney Disease, and Hypertension. Review of the Physician's Orders showed that Resident #280 had an order with a start date of 11/06/21 for daily weights for 3 days on every day shift. Review of the weights for Resident #280 showed that there were no weights documented on 11/06/21 or 11/07/21. Review of all progress notes dated 11/06/21 - 11/07/21 for Resident #280 showed that there were no notes regarding refusal of daily weights. Review of the Medication Administration Record (MAR) for November 2021 for Resident #280 showed that there was no documentation regarding daily weights for 11/06/21 - 11/07/21. Review of the Care Plan dated 11/06/21 documented that Resident #280 had the potential for further weight loss, skin breakdown, and further alteration in nutrition/hydration status. During an observation conducted on 11/07/21 at 10:45 AM, Resident #280 was observed laying in her bed. Resident #280 appeared thin with sunken cheeks and hollow orbital regions. When asked if she had lost any weight, she stated, I would imagine so. I don't eat very much. During an observation conducted on 11/08/21 at 8:38 AM, Resident #280's breakfast tray contained a muffin, sausage links, a cup of coffee, a cup of orange juice, and a container of Raisin Bran cereal. It was noted that Resident #280 had only taken a few small bites of her muffin, showing that she had consumed less than 25% of her meal. When asked if she was still hungry, Resident #280 stated that she was done with her breakfast. During an observation conducted on 11/09/21 at 8:22 AM, Resident #280 was observed in her bed with her breakfast meal untouched on her overbed table. When asked about her meal, Resident #280 stated that she did not want to eat breakfast. During an interview conducted on 11/10/21 at 9:02 AM, Staff E, Registered Dietitian, stated that 105360 Page 7 of 9 105360 11/10/2021 Tamarac Center for Rehabilitation and Healing 7901 NW 88th Avenue Tamarac, FL 33321

F 0692 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few upon admission, weights were taken daily for 3 days, weekly until stable, and then monthly thereafter. According to her, nursing was responsible for taking weights. She further stated that the nurse assigned to the resident was responsible for taking their daily admission weights. When asked, Staff E stated that weights were documented in PointClickCare (electronic charting system) and that nurses were responsible for entering the daily admission weights into PointClickCare. She further stated that nursing would know if a resident required daily weights because it would be placed as an order and would appear in their MAR. According to her, residents with a low body mass index, abnormal albumin, poor intake, elevated blood urea nitrogen, and skin alterations were at high nutritional risk. When asked about Resident #280, Staff E reviewed her chart and confirmed that there was no documentation showing that she refused to be weighed on 11/06/21 or 11/07/21. Upon further review of Resident #280's chart, Staff E confirmed that there was no documentation for daily weights on 11/06/21 or 11/07/21. This showed that the Physician's Order for daily weights for three days was not followed. 2. Review of the record showed that Resident #283 was re-admitted to the facility on [DATE] with the following diagnoses: Heart Failure, Unstageable Pressure Ulcer of Sacral Region, Type 2 Diabetes Mellitus, Atherosclerotic Heart Disease, and Dementia. Review of the Physician's Orders showed that Resident #283 had an order with a start date of 11/05/21 for daily weights for 3 days on every day shift. Review of the weights for Resident #283 showed that there were no weights documented on 11/05/21, 11/06/21, or 11/07/21. Review of all progress notes dated 11/05/21 - 11/07/21 for Resident #283 showed that there were no notes regarding refusal of daily weights. Review of the MAR for November 2021 for Resident #283 showed that there was no documentation regarding daily weights for 11/05/21 - 11/07/21. Review of the Baseline Care Plan dated 11/04/21 documented that Resident #283 was at risk for dehydration and potential for weight loss. During an observation conducted on 11/07/21 at 10:14 AM, Resident #283 was observed sleeping in his bed. Resident #283 appeared thin with sunken cheeks and hollow orbital regions. During an interview conducted on 11/10/21 at 9:02 AM, Staff E reviewed Resident #283's chart and confirmed that there was no documentation showing that he refused to be weighed on 11/05/21, 11/06/21, or 11/07/21. Upon further review of Resident #283's chart, Staff E confirmed that there was no documentation for daily weights on 11/05/21, 11/06/21, or 1/07/21. This showed that the Physician's Order for daily weights for three days was not followed. 3.Review of the record showed that Resident #330 was admitted to the facility on [DATE] with the following diagnoses: Atherosclerotic Hearth Disease, Chronic Obstructive Pulmonary Disease, Essential Hypertension, Hyperlipidemia, Hypothyroidism Review of the Physician's Orders showed that Resident #330 had an order with a start date of 11/06/21 for daily weights for 3 days. 105360 Page 8 of 9 105360 11/10/2021 Tamarac Center for Rehabilitation and Healing 7901 NW 88th Avenue Tamarac, FL 33321

F 0692 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the Care Plan dated 11/05/21 documented that Resident #330 has potential for weight loss, skin breakdown and alteration in nutrition/hydration status. Goals were to meet Nutrition and hydration needs as evidenced by no significant weight loss, labs maintained within acceptable range and no skin breakdown by next review date. Review of the weights for Resident #330 showed that there were no weights for 11/06/21, 11/07/21, and 11/08/21. Review of all progress notes dated 11/06/21 - 11/08/21 showed there was no documentation showing Resident #330 refused daily weights. Review of the Medication Administration Record (MAR)dated November 2021, for Resident#330 showed there was no documentation for daily weights on 11/06/21 - 11/07/21. During an interview on 11/10/21 at 9:02 AM, Staff E, Registered Dietician, was asked about the daily weights for Resident #330. Upon further review of the chart, she confirmed that there was no documentation for daily weights on 11/06/21, and 11/07/21 for Resident #330. This showed that the physician's order for daily weights for three days were not followed. 105360 Page 9 of 9